Provider Demographics
NPI:1336308584
Name:WACO ACUPUNCTURE CLINIC, PLLC
Entity Type:Organization
Organization Name:WACO ACUPUNCTURE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PEICHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:TXLAC
Authorized Official - Phone:254-772-9812
Mailing Address - Street 1:6801 SANGER AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7825
Mailing Address - Country:US
Mailing Address - Phone:254-772-9812
Mailing Address - Fax:254-772-9813
Practice Address - Street 1:6801 SANGER AVE STE 280
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7825
Practice Address - Country:US
Practice Address - Phone:254-772-9812
Practice Address - Fax:254-772-9813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00783171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty