Provider Demographics
NPI:1407113665
Name:ORIENTAL BODYWORK & ACUPUNCTURE CLINIC, S.C.
Entity Type:Organization
Organization Name:ORIENTAL BODYWORK & ACUPUNCTURE CLINIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:DIPL AC,L AC
Authorized Official - Phone:262-716-3771
Mailing Address - Street 1:313 WEST BELTLINE HWY
Mailing Address - Street 2:SUITE # 133
Mailing Address - City:MADISON,
Mailing Address - State:WI
Mailing Address - Zip Code:53713
Mailing Address - Country:US
Mailing Address - Phone:262-716-3771
Mailing Address - Fax:
Practice Address - Street 1:313 WEST BELTLINE HWY
Practice Address - Street 2:SUITE # 133
Practice Address - City:MADISON,
Practice Address - State:WI
Practice Address - Zip Code:53713
Practice Address - Country:US
Practice Address - Phone:262-716-3771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI#160-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty