Provider Demographics
NPI:1851702740
Name:LIVING WELL ACUPUNCTURE PA
Entity Type:Organization
Organization Name:LIVING WELL ACUPUNCTURE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOM AP
Authorized Official - Prefix:DR
Authorized Official - First Name:REYNA
Authorized Official - Middle Name:Q
Authorized Official - Last Name:BRAGG
Authorized Official - Suffix:
Authorized Official - Credentials:DOM AP
Authorized Official - Phone:941-301-6940
Mailing Address - Street 1:3653 CORTEZ RD W STE 120
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3168
Mailing Address - Country:US
Mailing Address - Phone:941-301-6940
Mailing Address - Fax:
Practice Address - Street 1:3653 CORTEZ RD W STE 120
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3168
Practice Address - Country:US
Practice Address - Phone:941-301-6940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3445261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health