Provider Demographics
NPI:1346963253
Name:MIRA INTEGRATIVE CLINIC
Entity Type:Organization
Organization Name:MIRA INTEGRATIVE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYSOUN
Authorized Official - Middle Name:HAMID
Authorized Official - Last Name:MIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MSA, LAC
Authorized Official - Phone:703-732-9915
Mailing Address - Street 1:2701 CHAIN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-5302
Mailing Address - Country:US
Mailing Address - Phone:703-732-9915
Mailing Address - Fax:
Practice Address - Street 1:2557 CHAIN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22181-5517
Practice Address - Country:US
Practice Address - Phone:703-705-7555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty