Provider Demographics
NPI:1619159258
Name:GREEN CRESCENT HERBS & ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:GREEN CRESCENT HERBS & ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAIYAD
Authorized Official - Middle Name:SALAHUDDIN
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:214-718-7646
Mailing Address - Street 1:13520 T I BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1420
Mailing Address - Country:US
Mailing Address - Phone:214-718-7646
Mailing Address - Fax:972-671-1158
Practice Address - Street 1:13520 T I BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1420
Practice Address - Country:US
Practice Address - Phone:214-718-7646
Practice Address - Fax:972-671-1158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00653171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty