Provider Demographics
NPI:1760553374
Name:MIND & BODY ACUPUNCTURE AND HERB CENTER
Entity Type:Organization
Organization Name:MIND & BODY ACUPUNCTURE AND HERB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:LI
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:360-253-3488
Mailing Address - Street 1:3200 SE 164TH AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-1108
Mailing Address - Country:US
Mailing Address - Phone:360-253-3488
Mailing Address - Fax:360-253-3488
Practice Address - Street 1:3200 SE 164TH AVE STE 212
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1108
Practice Address - Country:US
Practice Address - Phone:360-253-3488
Practice Address - Fax:360-253-3488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000754171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty