Provider Demographics
NPI:1710626452
Name:ACUPUNCTURE CLINIC OF FWB LLC
Entity Type:Organization
Organization Name:ACUPUNCTURE CLINIC OF FWB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:XU NAN
Authorized Official - Middle Name:
Authorized Official - Last Name:XIANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-864-1688
Mailing Address - Street 1:51 BEAL PKWY NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4819
Mailing Address - Country:US
Mailing Address - Phone:850-864-1688
Mailing Address - Fax:850-999-7585
Practice Address - Street 1:51 BEAL PKWY NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4819
Practice Address - Country:US
Practice Address - Phone:850-864-1688
Practice Address - Fax:850-999-7585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty