Provider Demographics
NPI:1306204300
Name:THE TREE OF LIFE ACUPUNCTURE
Entity Type:Organization
Organization Name:THE TREE OF LIFE ACUPUNCTURE
Other - Org Name:MELISSA BERG LAC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:707-822-7400
Mailing Address - Street 1:1460 G ST
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-5610
Mailing Address - Country:US
Mailing Address - Phone:707-822-7400
Mailing Address - Fax:707-822-2338
Practice Address - Street 1:1460 G ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-5610
Practice Address - Country:US
Practice Address - Phone:707-822-7400
Practice Address - Fax:707-822-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty