Provider Demographics
NPI:1790360113
Name:RESTORATION ACUPUNCTURE CENTER
Entity Type:Organization
Organization Name:RESTORATION ACUPUNCTURE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORNER, ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:KALEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:812-255-0277
Mailing Address - Street 1:903 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-3107
Mailing Address - Country:US
Mailing Address - Phone:812-255-0277
Mailing Address - Fax:812-255-0272
Practice Address - Street 1:903 N 7TH ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-3107
Practice Address - Country:US
Practice Address - Phone:812-255-0277
Practice Address - Fax:812-255-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty