Provider Demographics
NPI:1649779406
Name:MICHIGAN ACUPUNCTURE STUDIO LLC
Entity Type:Organization
Organization Name:MICHIGAN ACUPUNCTURE STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-470-0155
Mailing Address - Street 1:2300 HAGGERTY RD STE 1190
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2188
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2300 HAGGERTY RD STE 1190
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2188
Practice Address - Country:US
Practice Address - Phone:248-470-0155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5401000220171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty