Provider Demographics
NPI:1528362688
Name:OAKLAND ACUPUNCTURE & INTEGRATIVE MEDICINE CLINIC
Entity Type:Organization
Organization Name:OAKLAND ACUPUNCTURE & INTEGRATIVE MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:AUGUST-GUSTAVUS
Authorized Official - Middle Name:AURELIUS
Authorized Official - Last Name:VARLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MS ACUPUNCTURE
Authorized Official - Phone:800-263-4232
Mailing Address - Street 1:428 E 19TH ST
Mailing Address - Street 2:#6
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-1829
Mailing Address - Country:US
Mailing Address - Phone:800-263-4232
Mailing Address - Fax:
Practice Address - Street 1:431 30TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3307
Practice Address - Country:US
Practice Address - Phone:800-263-4232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30376111N00000X
CA13955171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty