Provider Demographics
NPI:1922341635
Name:PHYSICIAN'S ACUPUNCTURE, LLC
Entity Type:Organization
Organization Name:PHYSICIAN'S ACUPUNCTURE, LLC
Other - Org Name:MD SCIENTIFIC ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRIGORY
Authorized Official - Middle Name:V
Authorized Official - Last Name:CHERNYAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-326-1885
Mailing Address - Street 1:1405 NIGHTHAWK DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6112
Mailing Address - Country:US
Mailing Address - Phone:405-326-1885
Mailing Address - Fax:
Practice Address - Street 1:105 S BRYANT AVE STE 404
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6331
Practice Address - Country:US
Practice Address - Phone:405-431-0804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23791207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty