Provider Demographics
NPI:1346624137
Name:KEYSTONE FAMILY ACUPUNCTURE, INC.
Entity Type:Organization
Organization Name:KEYSTONE FAMILY ACUPUNCTURE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:CAROLLE
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DA, LICAC
Authorized Official - Phone:401-272-8262
Mailing Address - Street 1:120 DUDLEY STREET
Mailing Address - Street 2:SUITE103
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2431
Mailing Address - Country:US
Mailing Address - Phone:401-272-8262
Mailing Address - Fax:401-421-2016
Practice Address - Street 1:120 DUDLEY STREET
Practice Address - Street 2:SUITE103
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-2431
Practice Address - Country:US
Practice Address - Phone:401-272-8262
Practice Address - Fax:401-421-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-12
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00372171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty