Provider Demographics
NPI:1891314944
Name:AMBULANT ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:AMBULANT ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:MACOM LAC LMT
Authorized Official - Phone:907-255-8413
Mailing Address - Street 1:300 N WILLSON AVE STE 602F-2
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3551
Mailing Address - Country:US
Mailing Address - Phone:907-255-8413
Mailing Address - Fax:406-720-7899
Practice Address - Street 1:300 N WILLSON AVE STE 602F-2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3551
Practice Address - Country:US
Practice Address - Phone:907-255-8413
Practice Address - Fax:406-720-7899
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMBULANT ACUPUNCTURE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty