Provider Demographics
NPI:1619404100
Name:WHITE BLOSSOM ACUPUNCTURE & WELLNESS CLINIC, LLC
Entity Type:Organization
Organization Name:WHITE BLOSSOM ACUPUNCTURE & WELLNESS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LEWIS-BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:970-987-1754
Mailing Address - Street 1:321 OAK LN
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-2186
Mailing Address - Country:US
Mailing Address - Phone:970-987-1754
Mailing Address - Fax:
Practice Address - Street 1:320 W MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1614
Practice Address - Country:US
Practice Address - Phone:970-315-2445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty