Provider Demographics
NPI:1710767298
Name:STILL LIFE ACUPUNCTURE
Entity Type:Organization
Organization Name:STILL LIFE ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/TREASURER/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STOLPER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:707-583-3226
Mailing Address - Street 1:213 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-6625
Mailing Address - Country:US
Mailing Address - Phone:805-458-4506
Mailing Address - Fax:
Practice Address - Street 1:213 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-6625
Practice Address - Country:US
Practice Address - Phone:707-583-3226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Multi-Specialty