Provider Demographics
NPI:1316575939
Name:PEREGRINE ACUPUNCTURE
Entity Type:Organization
Organization Name:PEREGRINE ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HASKELL
Authorized Official - Suffix:
Authorized Official - Credentials:LIC, AC
Authorized Official - Phone:207-222-3109
Mailing Address - Street 1:178 LOWER MAIN ST STE 11
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-1001
Mailing Address - Country:US
Mailing Address - Phone:207-222-3109
Mailing Address - Fax:
Practice Address - Street 1:178 LOWER MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-1001
Practice Address - Country:US
Practice Address - Phone:207-222-3109
Practice Address - Fax:207-222-3109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-30
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty