Provider Demographics
NPI:1376179937
Name:MOON RABBIT ACUPUNCTURE & EASTERN MEDICINE LLC
Entity Type:Organization
Organization Name:MOON RABBIT ACUPUNCTURE & EASTERN MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:GUDRUN
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DAC, LAC
Authorized Official - Phone:781-367-3356
Mailing Address - Street 1:18 N ADA ST UNIT E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2141
Mailing Address - Country:US
Mailing Address - Phone:781-367-3356
Mailing Address - Fax:
Practice Address - Street 1:1111 W MADISON ST STE 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2055
Practice Address - Country:US
Practice Address - Phone:781-367-3356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty