Provider Demographics
NPI:1477010403
Name:PALM BEACH ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:PALM BEACH ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PICKENS
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:GANTT
Authorized Official - Suffix:III
Authorized Official - Credentials:LAC
Authorized Official - Phone:561-533-7475
Mailing Address - Street 1:1505 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-1964
Mailing Address - Country:US
Mailing Address - Phone:561-533-7475
Mailing Address - Fax:
Practice Address - Street 1:1505 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-1964
Practice Address - Country:US
Practice Address - Phone:561-533-7475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No175L00000XOther Service ProvidersHomeopathGroup - Multi-Specialty