Provider Demographics
NPI:1700035300
Name:TAKAMATSU, BUNZO (L AC)
Entity Type:Individual
Prefix:
First Name:BUNZO
Middle Name:
Last Name:TAKAMATSU
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12700 PRESTON RD STE 255
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1877
Mailing Address - Country:US
Mailing Address - Phone:972-701-8755
Mailing Address - Fax:
Practice Address - Street 1:12700 PRESTON RD STE 255
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1877
Practice Address - Country:US
Practice Address - Phone:972-701-8755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00145171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist