Provider Demographics
NPI:1922660638
Name:STARLIGHT ACUPUNCTURE & HOLISTIC WELLNESS PLLC
Entity Type:Organization
Organization Name:STARLIGHT ACUPUNCTURE & HOLISTIC WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENOWETH
Authorized Official - Suffix:
Authorized Official - Credentials:EAMP, LAC
Authorized Official - Phone:360-209-4551
Mailing Address - Street 1:11110 SE TOLA RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-7900
Mailing Address - Country:US
Mailing Address - Phone:858-229-6496
Mailing Address - Fax:
Practice Address - Street 1:11110 SE TOLA RD
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-7900
Practice Address - Country:US
Practice Address - Phone:858-229-6496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty