Provider Demographics
NPI:1184986333
Name:TRILOGY ACUPUNCTURE WELLNESS CENTER, INC.45
Entity type:Organization
Organization Name:TRILOGY ACUPUNCTURE WELLNESS CENTER, INC.45
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM (DR OF ACUPUNCT
Authorized Official - Phone:928-772-5575
Mailing Address - Street 1:8113 E FLORENTINE RD STE A
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-8461
Mailing Address - Country:US
Mailing Address - Phone:928-772-5575
Mailing Address - Fax:928-772-5575
Practice Address - Street 1:8113 E FLORENTINE RD STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8461
Practice Address - Country:US
Practice Address - Phone:928-772-5575
Practice Address - Fax:928-772-5575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1780849455OtherACUPUNCTURE