Provider Demographics
NPI:1437647864
Name:WHITE CRANE ACUPUNCTURE
Entity Type:Organization
Organization Name:WHITE CRANE ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MACOM,LAC
Authorized Official - Phone:719-248-4820
Mailing Address - Street 1:2701 N ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3643
Mailing Address - Country:US
Mailing Address - Phone:719-248-4820
Mailing Address - Fax:
Practice Address - Street 1:2701 N ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3643
Practice Address - Country:US
Practice Address - Phone:719-248-4820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001156261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center