Provider Demographics
NPI:1558727065
Name:INTEGRA ACUPUNCTURE AND WELLNESS
Entity Type:Organization
Organization Name:INTEGRA ACUPUNCTURE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NING
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:614-266-3885
Mailing Address - Street 1:1100 BEECHER XING N
Mailing Address - Street 2:SUITE D
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4565
Mailing Address - Country:US
Mailing Address - Phone:614-855-8828
Mailing Address - Fax:614-855-8836
Practice Address - Street 1:1100 BEECHER XING N
Practice Address - Street 2:SUITE D
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-4565
Practice Address - Country:US
Practice Address - Phone:614-855-8828
Practice Address - Fax:614-855-8836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH56171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty