Provider Demographics
NPI:1437293636
Name:LIVING WELL ACUPUNCTURE
Entity Type:Organization
Organization Name:LIVING WELL ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEEDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-268-9433
Mailing Address - Street 1:1905 KNOX MCRAE DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-5359
Mailing Address - Country:US
Mailing Address - Phone:321-268-9433
Mailing Address - Fax:321-383-0405
Practice Address - Street 1:1905 KNOX MCRAE DR
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-5359
Practice Address - Country:US
Practice Address - Phone:321-268-9433
Practice Address - Fax:321-383-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2301171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty