Provider Demographics
NPI:1659930931
Name:BIG EASY ACUPUNCTURE & HERBAL MEDICINE
Entity type:Organization
Organization Name:BIG EASY ACUPUNCTURE & HERBAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURTIST
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BRAUD
Authorized Official - Suffix:JR
Authorized Official - Credentials:LAC
Authorized Official - Phone:504-650-0027
Mailing Address - Street 1:3913 N I 10 SERVICE RD W APT 201
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-6854
Mailing Address - Country:US
Mailing Address - Phone:504-650-0027
Mailing Address - Fax:
Practice Address - Street 1:4300 S I 10 SERVICE RD W STE 208
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-7431
Practice Address - Country:US
Practice Address - Phone:504-650-0027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No251E00000XAgenciesHome Health