Provider Demographics
NPI:1457856189
Name:ISLAND ACUPUNCTURE AND MASSAGE THERAPY, INC
Entity Type:Organization
Organization Name:ISLAND ACUPUNCTURE AND MASSAGE THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:252-449-8122
Mailing Address - Street 1:5553 N CROATAN HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN SHORES
Mailing Address - State:NC
Mailing Address - Zip Code:27949-4117
Mailing Address - Country:US
Mailing Address - Phone:252-449-8122
Mailing Address - Fax:252-441-4080
Practice Address - Street 1:5553 N CROATAN HWY
Practice Address - Street 2:
Practice Address - City:SOUTHERN SHORES
Practice Address - State:NC
Practice Address - Zip Code:27949-4117
Practice Address - Country:US
Practice Address - Phone:252-449-8122
Practice Address - Fax:252-441-4080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty