Provider Demographics
NPI:1619385432
Name:DONNA HENDERSON ACUPUNCTURE, INC
Entity Type:Organization
Organization Name:DONNA HENDERSON ACUPUNCTURE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:352-222-1679
Mailing Address - Street 1:PO BOX 2022
Mailing Address - Street 2:
Mailing Address - City:KEYSTONE HEIGHTS
Mailing Address - State:FL
Mailing Address - Zip Code:32656-2022
Mailing Address - Country:US
Mailing Address - Phone:352-222-1679
Mailing Address - Fax:
Practice Address - Street 1:6585 BROOKLYN BAY RD
Practice Address - Street 2:
Practice Address - City:KEYSTONE HEIGHTS
Practice Address - State:FL
Practice Address - Zip Code:32656-7845
Practice Address - Country:US
Practice Address - Phone:352-222-1679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty