Provider Demographics
NPI:1598297897
Name:INVIGORATING ACUPUNCTURE AND QIGONG
Entity Type:Organization
Organization Name:INVIGORATING ACUPUNCTURE AND QIGONG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:940-441-5404
Mailing Address - Street 1:524 N LOCUST ST STE J
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4140
Mailing Address - Country:US
Mailing Address - Phone:940-441-5404
Mailing Address - Fax:
Practice Address - Street 1:524 N LOCUST ST STE J
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4140
Practice Address - Country:US
Practice Address - Phone:940-441-5404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01296171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty