Provider Demographics
NPI:1003336256
Name:GOLDEN WAY ACUPUNCTURE
Entity type:Organization
Organization Name:GOLDEN WAY ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMPANERI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:530-859-3839
Mailing Address - Street 1:6556 COLEMAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-9667
Mailing Address - Country:US
Mailing Address - Phone:530-859-3839
Mailing Address - Fax:
Practice Address - Street 1:120 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1935
Practice Address - Country:US
Practice Address - Phone:530-859-3839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR107805171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty