Provider Demographics
NPI:1578955266
Name:SLO ACUPUNCTURE & INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:SLO ACUPUNCTURE & INTEGRATIVE MEDICINE
Other - Org Name:SLO ACUPUNCTURE & INTEGRATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TOMICH
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:805-748-8885
Mailing Address - Street 1:4251 S HIGUERA ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7741
Mailing Address - Country:US
Mailing Address - Phone:805-704-8825
Mailing Address - Fax:
Practice Address - Street 1:4251 S HIGUERA ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7700
Practice Address - Country:US
Practice Address - Phone:805-704-8825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13997171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty