Provider Demographics
NPI:1679096978
Name:ADA ACUPUNCTURE CLINIC, TCM AND PAIN LLC
Entity Type:Organization
Organization Name:ADA ACUPUNCTURE CLINIC, TCM AND PAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:SOLESBEE
Authorized Official - Suffix:
Authorized Official - Credentials:MSAOM
Authorized Official - Phone:580-447-1530
Mailing Address - Street 1:106 SHADY GRV
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-2009
Mailing Address - Country:US
Mailing Address - Phone:703-608-9018
Mailing Address - Fax:
Practice Address - Street 1:7240 CR 1525
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820
Practice Address - Country:US
Practice Address - Phone:580-447-1530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02405171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty