Provider Demographics
NPI:1922639921
Name:321 ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:321 ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURE PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURR
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:407-572-5849
Mailing Address - Street 1:871 HAWAII AVE NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-7763
Mailing Address - Country:US
Mailing Address - Phone:407-572-5849
Mailing Address - Fax:
Practice Address - Street 1:5200 BABCOCK ST NE STE 201
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4644
Practice Address - Country:US
Practice Address - Phone:407-572-5849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty