Provider Demographics
NPI:1740429984
Name:FOUR WINDS ACUPUNCTURE
Entity Type:Organization
Organization Name:FOUR WINDS ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CARON
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, AP, LMT
Authorized Official - Phone:386-677-5400
Mailing Address - Street 1:115 E GRANADA BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-6634
Mailing Address - Country:US
Mailing Address - Phone:386-677-5400
Mailing Address - Fax:386-677-5420
Practice Address - Street 1:115 E GRANADA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-6634
Practice Address - Country:US
Practice Address - Phone:386-677-5400
Practice Address - Fax:386-677-5420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2427171100000X
FLMA35023174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty