Provider Demographics
NPI:1639697634
Name:THE PAMPERED PORCUPINE ACUPUNCTURE, INC.
Entity Type:Organization
Organization Name:THE PAMPERED PORCUPINE ACUPUNCTURE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:T
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-450-6512
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:SCOTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06264-0179
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12 PALMER ROAD
Practice Address - Street 2:
Practice Address - City:SCOTLAND
Practice Address - State:CT
Practice Address - Zip Code:06264
Practice Address - Country:US
Practice Address - Phone:860-450-6512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT637171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty