Provider Demographics
NPI:1538508759
Name:INTEGRATIVE ORIENTAL MEDICINE LLC
Entity Type:Organization
Organization Name:INTEGRATIVE ORIENTAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURE PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-889-6662
Mailing Address - Street 1:5560A N OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEAN RIDGE
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7038
Mailing Address - Country:US
Mailing Address - Phone:561-889-6662
Mailing Address - Fax:
Practice Address - Street 1:2247 PALM BEACH LAKES BLVD
Practice Address - Street 2:SUITE 204B
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3470
Practice Address - Country:US
Practice Address - Phone:561-889-6662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1583171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty