Provider Demographics
NPI:1568853224
Name:ON THE GO ACUPUNCTURE
Entity Type:Organization
Organization Name:ON THE GO ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:IKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-668-4002
Mailing Address - Street 1:3030 NE 21ST TER
Mailing Address - Street 2:8
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1251
Mailing Address - Country:US
Mailing Address - Phone:954-668-4002
Mailing Address - Fax:
Practice Address - Street 1:3030 NE 21ST TER
Practice Address - Street 2:8
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1251
Practice Address - Country:US
Practice Address - Phone:954-668-4002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3395261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP3395OtherACUPUNCTURIST