Provider Demographics
NPI:1891816484
Name:ABUNDANCE ACUPUNCTURE INC.
Entity Type:Organization
Organization Name:ABUNDANCE ACUPUNCTURE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:FRIEDRICHS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:920-356-1578
Mailing Address - Street 1:119 E MACKIE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-2031
Mailing Address - Country:US
Mailing Address - Phone:920-356-1578
Mailing Address - Fax:920-356-9111
Practice Address - Street 1:119 E MACKIE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-2031
Practice Address - Country:US
Practice Address - Phone:920-356-1578
Practice Address - Fax:920-356-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI239055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty