Provider Demographics
NPI:1689949158
Name:INDY ACUPUNCTURE & HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:INDY ACUPUNCTURE & HEALTH SERVICES, INC.
Other - Org Name:INDY DOWNTOWN COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST/ PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:317-255-3030
Mailing Address - Street 1:6155 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1957
Mailing Address - Country:US
Mailing Address - Phone:317-255-3030
Mailing Address - Fax:317-255-3035
Practice Address - Street 1:6155 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1957
Practice Address - Country:US
Practice Address - Phone:317-255-3030
Practice Address - Fax:317-255-3035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-17
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000075A171100000X
171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN84000075AOtherNCCAOM