Provider Demographics
NPI:1407029820
Name:MULBERRY ORIENTAL MEDICINE INC
Entity Type:Organization
Organization Name:MULBERRY ORIENTAL MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHESHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC,
Authorized Official - Phone:352-430-2720
Mailing Address - Street 1:910 OLD CAMP RD
Mailing Address - Street 2:#164
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32162-5604
Mailing Address - Country:US
Mailing Address - Phone:352-430-2720
Mailing Address - Fax:352-430-2724
Practice Address - Street 1:910 OLD CAMP RD
Practice Address - Street 2:#164
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32162-5604
Practice Address - Country:US
Practice Address - Phone:352-430-2720
Practice Address - Fax:352-430-2724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2152171100000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty