Provider Demographics
NPI:1962676387
Name:MANATEE INTEGRATED ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:MANATEE INTEGRATED ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, AP, DOM
Authorized Official - Phone:941-751-8008
Mailing Address - Street 1:3210 SOUTHERN PKWY W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-2938
Mailing Address - Country:US
Mailing Address - Phone:941-751-8008
Mailing Address - Fax:
Practice Address - Street 1:3653 CORTEZ RD W STE 120
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3168
Practice Address - Country:US
Practice Address - Phone:941-751-8008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2468171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty