Provider Demographics
NPI:1952853863
Name:MAYFLOWER ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:MAYFLOWER ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:PAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-413-2118
Mailing Address - Street 1:536 HOPMEADOW ST
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-2415
Mailing Address - Country:US
Mailing Address - Phone:860-413-2118
Mailing Address - Fax:860-831-0318
Practice Address - Street 1:536 HOPMEADOW ST
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-2415
Practice Address - Country:US
Practice Address - Phone:860-413-2118
Practice Address - Fax:860-831-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT512171100000X
HI265171100000X
261QH0100X, 261QM2500X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Multi-Specialty