Provider Demographics
NPI:1891210878
Name:OHIO ACUPUNCTURE AND CHINESE HERBAL MEDICINE, LLC
Entity Type:Organization
Organization Name:OHIO ACUPUNCTURE AND CHINESE HERBAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:847-928-8711
Mailing Address - Street 1:104 S ARDMORE RD
Mailing Address - Street 2:
Mailing Address - City:BEXLEY
Mailing Address - State:OH
Mailing Address - Zip Code:43209-1705
Mailing Address - Country:US
Mailing Address - Phone:857-928-8711
Mailing Address - Fax:
Practice Address - Street 1:100 W 3RD AVE STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-3256
Practice Address - Country:US
Practice Address - Phone:614-233-1609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000230171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty