Provider Demographics
NPI:1922535046
Name:BENSHEN ACUPUNCTURE AND HERBS
Entity Type:Organization
Organization Name:BENSHEN ACUPUNCTURE AND HERBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURE PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CACOLICI
Authorized Official - Suffix:
Authorized Official - Credentials:AP LAC
Authorized Official - Phone:954-465-6531
Mailing Address - Street 1:2095 N ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-1420
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1732 NE 26TH ST STE 202
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1448
Practice Address - Country:US
Practice Address - Phone:954-465-6531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENSHEN ACUPUNCTURE AND HERBS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-19
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3644171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty