Provider Demographics
NPI:1760691422
Name:TRIANGLE ACUPUNCTURE CLINIC, LLC
Entity Type:Organization
Organization Name:TRIANGLE ACUPUNCTURE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOMHOWER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:919-933-4480
Mailing Address - Street 1:104 S ESTES DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2866
Mailing Address - Country:US
Mailing Address - Phone:919-933-4480
Mailing Address - Fax:919-265-0373
Practice Address - Street 1:104 S ESTES DR
Practice Address - Street 2:SUITE 104
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2866
Practice Address - Country:US
Practice Address - Phone:919-933-4480
Practice Address - Fax:919-265-0373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC277171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty