Provider Demographics
NPI:1750815296
Name:INTEGRATIVE ACUPUNCTURE & HEALING CENTER
Entity Type:Organization
Organization Name:INTEGRATIVE ACUPUNCTURE & HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIPLOMATE OF ORIENTAL MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, LAP, RN
Authorized Official - Phone:386-215-1387
Mailing Address - Street 1:317 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3483
Mailing Address - Country:US
Mailing Address - Phone:386-215-1387
Mailing Address - Fax:
Practice Address - Street 1:317 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3483
Practice Address - Country:US
Practice Address - Phone:386-215-1387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3330171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1548660640OtherBCBS, AETNA, HUMANA, CIGNA