Provider Demographics
NPI:1760705404
Name:ADBO LLC
Entity Type:Organization
Organization Name:ADBO LLC
Other - Org Name:DANCING BEAR HEALING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,CAHT,LAC
Authorized Official - Phone:480-422-7000
Mailing Address - Street 1:1784 E VISTA DE MONTANA
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-6957
Mailing Address - Country:US
Mailing Address - Phone:480-422-7000
Mailing Address - Fax:
Practice Address - Street 1:989 S MAIN ST, STE A#431
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4602
Practice Address - Country:US
Practice Address - Phone:480-422-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0711171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty