Provider Demographics
NPI:1407388150
Name:ONSITE HOLISTICS AND INTEGRATIVE MEDICINE, LLC
Entity Type:Organization
Organization Name:ONSITE HOLISTICS AND INTEGRATIVE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUAH
Authorized Official - Middle Name:C
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:407-490-3852
Mailing Address - Street 1:4409 HOFFNER AVE
Mailing Address - Street 2:# 258
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-2331
Mailing Address - Country:US
Mailing Address - Phone:407-490-3812
Mailing Address - Fax:
Practice Address - Street 1:4409 HOFFNER AVE
Practice Address - Street 2:# 258
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-2331
Practice Address - Country:US
Practice Address - Phone:407-490-3812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3478171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty