Provider Demographics
NPI:1124645023
Name:WATERFRONT ACUPUNCTURE & WELLNESS, LLC
Entity type:Organization
Organization Name:WATERFRONT ACUPUNCTURE & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREW
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LAC
Authorized Official - Phone:508-287-5529
Mailing Address - Street 1:225 WATER ST STE B239
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4080
Mailing Address - Country:US
Mailing Address - Phone:508-685-9556
Mailing Address - Fax:
Practice Address - Street 1:225 WATER ST STE B239
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4080
Practice Address - Country:US
Practice Address - Phone:508-685-9556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty