Provider Demographics
NPI:1659757029
Name:GREEN ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:GREEN ACUPUNCTURE LLC
Other - Org Name:GREEN ACUPUNCTURE & INTEGRATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/SENIOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:AP DOM
Authorized Official - Phone:561-244-5424
Mailing Address - Street 1:8198 S JOG RD STE 203
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-6903
Mailing Address - Country:US
Mailing Address - Phone:561-244-5424
Mailing Address - Fax:
Practice Address - Street 1:8198 S JOG RD STE 203
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-6903
Practice Address - Country:US
Practice Address - Phone:561-244-5424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3526171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty