Provider Demographics
NPI:1629341961
Name:GREATER DAYTON ACUPUNCTURE AND MASSAGE
Entity Type:Organization
Organization Name:GREATER DAYTON ACUPUNCTURE AND MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BECKNELL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:937-204-5760
Mailing Address - Street 1:701 UNION BLVD
Mailing Address - Street 2:#114
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45315-9772
Mailing Address - Country:US
Mailing Address - Phone:937-204-5760
Mailing Address - Fax:
Practice Address - Street 1:6840 LOOP RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2159
Practice Address - Country:US
Practice Address - Phone:937-204-5760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000220171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty