Provider Demographics
NPI:1609323385
Name:ACUESSENCE, LLC
Entity Type:Organization
Organization Name:ACUESSENCE, LLC
Other - Org Name:SUWANNEE RIVER COMMUNITY ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:THEVENAU
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:386-361-8462
Mailing Address - Street 1:835 167TH PL
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32060-8025
Mailing Address - Country:US
Mailing Address - Phone:281-658-5459
Mailing Address - Fax:
Practice Address - Street 1:312 OHIO AVE N
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-2457
Practice Address - Country:US
Practice Address - Phone:386-361-8462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3345171100000X
COACU.0001948171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty