Provider Demographics
NPI:1770855777
Name:WINTZER ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:WINTZER ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EAST ASIAN MEDICINE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:WINTZER
Authorized Official - Suffix:
Authorized Official - Credentials:EAMP
Authorized Official - Phone:360-851-4268
Mailing Address - Street 1:430 NE CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2144
Mailing Address - Country:US
Mailing Address - Phone:360-851-4268
Mailing Address - Fax:844-244-8288
Practice Address - Street 1:430 NE CEDAR ST
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2144
Practice Address - Country:US
Practice Address - Phone:360-851-4268
Practice Address - Fax:844-244-8288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60055845171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty