Provider Demographics
NPI:1942607973
Name:CADUCEUS ACUPUNTURE MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:CADUCEUS ACUPUNTURE MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KESNEL
Authorized Official - Middle Name:
Authorized Official - Last Name:THEUS
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:561-557-2138
Mailing Address - Street 1:1195 N MILITARY TRL
Mailing Address - Street 2:SUITE 5 B
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6058
Mailing Address - Country:US
Mailing Address - Phone:561-557-2138
Mailing Address - Fax:561-215-5059
Practice Address - Street 1:1195 N MILITARY TRL
Practice Address - Street 2:SUITE 5 B
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6058
Practice Address - Country:US
Practice Address - Phone:561-557-2138
Practice Address - Fax:561-215-5059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2382171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP2382OtherMEDICAL LICENSE