Provider Demographics
NPI:1689125130
Name:SLOWPOKE ACUPUNCTURE
Entity Type:Organization
Organization Name:SLOWPOKE ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPALTY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:415-412-1497
Mailing Address - Street 1:2921 FOLSOM ST APT A
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4027
Mailing Address - Country:US
Mailing Address - Phone:415-412-1497
Mailing Address - Fax:
Practice Address - Street 1:3150 18TH ST STE 547
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2074
Practice Address - Country:US
Practice Address - Phone:415-412-1497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16489171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty