Provider Demographics
NPI:1851777643
Name:TOTAL WELLNESS ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:TOTAL WELLNESS ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC MSOM
Authorized Official - Phone:480-437-0532
Mailing Address - Street 1:3201 W. PEORIA AVE
Mailing Address - Street 2:SUITE # C-607
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029
Mailing Address - Country:US
Mailing Address - Phone:480-437-0532
Mailing Address - Fax:
Practice Address - Street 1:3201 W. PEORIA AVE
Practice Address - Street 2:SUITE # C-607
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029
Practice Address - Country:US
Practice Address - Phone:480-437-0532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0999171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty