Provider Demographics
NPI:1467814046
Name:SIX BRANCHES FAMILY ACUPUNCTURE, LLC
Entity Type:Organization
Organization Name:SIX BRANCHES FAMILY ACUPUNCTURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:E
Authorized Official - Last Name:SKOGLUND
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:207-370-1535
Mailing Address - Street 1:619 BRIGHTON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2323
Mailing Address - Country:US
Mailing Address - Phone:207-370-1535
Mailing Address - Fax:844-308-4988
Practice Address - Street 1:619 BRIGHTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2323
Practice Address - Country:US
Practice Address - Phone:207-370-1535
Practice Address - Fax:844-308-4988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC533171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty