Provider Demographics
NPI:1871046755
Name:PROACTIVE ACUPUNCTURE INC
Entity Type:Organization
Organization Name:PROACTIVE ACUPUNCTURE INC
Other - Org Name:PROACTIVE ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:BRADEY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CIMINO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC 10821
Authorized Official - Phone:916-444-6047
Mailing Address - Street 1:2401 CAPITOL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5884
Mailing Address - Country:US
Mailing Address - Phone:916-444-6047
Mailing Address - Fax:916-444-3394
Practice Address - Street 1:2401 CAPITOL AVE STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5884
Practice Address - Country:US
Practice Address - Phone:916-444-6047
Practice Address - Fax:916-444-3394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1245413335OtherOFFICE IN SACRAMENTO CALIFORNIA, 11 YEARS AGO. I DONT REMEBER THE NAME.