Provider Demographics
NPI:1922247865
Name:CONCORD CENTER ACUPUNCTURE
Entity Type:Organization
Organization Name:CONCORD CENTER ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:N
Authorized Official - Last Name:SOUCY
Authorized Official - Suffix:
Authorized Official - Credentials:LIC AC, MAOM
Authorized Official - Phone:978-369-9400
Mailing Address - Street 1:91 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2571
Mailing Address - Country:US
Mailing Address - Phone:978-369-9400
Mailing Address - Fax:978-369-9400
Practice Address - Street 1:91 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2571
Practice Address - Country:US
Practice Address - Phone:978-369-9400
Practice Address - Fax:978-369-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230159171100000X
MA230158171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty