Provider Demographics
NPI:1558912568
Name:EAST COAST ACUPUNCTURE AND ALTERNATIVE MEDICINE
Entity Type:Organization
Organization Name:EAST COAST ACUPUNCTURE AND ALTERNATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEETERS
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:386-302-5363
Mailing Address - Street 1:99 OLD KINGS RD S STE 4
Mailing Address - Street 2:
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136-4356
Mailing Address - Country:US
Mailing Address - Phone:386-302-5363
Mailing Address - Fax:
Practice Address - Street 1:99 OLD KINGS RD S STE 4
Practice Address - Street 2:
Practice Address - City:FLAGLER BEACH
Practice Address - State:FL
Practice Address - Zip Code:32136-4356
Practice Address - Country:US
Practice Address - Phone:386-302-5363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty