Provider Demographics
NPI:1487001806
Name:SOUTHSIDE COMMUNITY ACUPUNCTURE, LLC
Entity Type:Organization
Organization Name:SOUTHSIDE COMMUNITY ACUPUNCTURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HONEA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:804-433-8558
Mailing Address - Street 1:8730 STONY POINT PKWY
Mailing Address - Street 2:SUITE 270
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-1970
Mailing Address - Country:US
Mailing Address - Phone:804-433-8558
Mailing Address - Fax:804-409-1705
Practice Address - Street 1:8730 STONY POINT PKWY
Practice Address - Street 2:SUITE 270
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1970
Practice Address - Country:US
Practice Address - Phone:804-433-8558
Practice Address - Fax:804-409-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121-0008804171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty