Provider Demographics
NPI:1740610666
Name:LIVE OAK ACUPUPUNCTURE & HERBAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:LIVE OAK ACUPUPUNCTURE & HERBAL MEDICINE, PLLC
Other - Org Name:LIVE OAK ACUPUPUNCTURE & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:HORNER
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:254-741-6030
Mailing Address - Street 1:201 OLD HEWITT ROAD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712
Mailing Address - Country:US
Mailing Address - Phone:254-741-6030
Mailing Address - Fax:
Practice Address - Street 1:201 OLD HEWITT ROAD
Practice Address - Street 2:SUITE D
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712
Practice Address - Country:US
Practice Address - Phone:254-741-6030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00703171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty