Provider Demographics
NPI:1922574813
Name:BANYAN ACUPUNCTURE, INC
Entity Type:Organization
Organization Name:BANYAN ACUPUNCTURE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNTURE
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-821-7015
Mailing Address - Street 1:2324 S CONGRESS AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7667
Mailing Address - Country:US
Mailing Address - Phone:561-408-0903
Mailing Address - Fax:561-408-0905
Practice Address - Street 1:2324 S CONGRESS AVE STE 1A
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-7667
Practice Address - Country:US
Practice Address - Phone:561-408-0903
Practice Address - Fax:561-408-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty