Provider Demographics
NPI:1609132703
Name:CLASSICAL HERBS AND ACUPUNCTURE, INC
Entity Type:Organization
Organization Name:CLASSICAL HERBS AND ACUPUNCTURE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:305-665-9711
Mailing Address - Street 1:9655 S DIXIE HWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2813
Mailing Address - Country:US
Mailing Address - Phone:305-665-9711
Mailing Address - Fax:
Practice Address - Street 1:9655 S DIXIE HWY
Practice Address - Street 2:SUITE 204
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-2813
Practice Address - Country:US
Practice Address - Phone:305-665-9711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP974261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC7258OtherBCBS
FLC0774OtherBCBS