Provider Demographics
NPI:1205956141
Name:BOONSBORO WELLNESS CENTER, INC.
Entity type:Organization
Organization Name:BOONSBORO WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WORTH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LAC
Authorized Official - Phone:301-432-4940
Mailing Address - Street 1:27 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOONSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21713-1236
Mailing Address - Country:US
Mailing Address - Phone:301-432-4940
Mailing Address - Fax:301-432-1120
Practice Address - Street 1:27 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONSBORO
Practice Address - State:MD
Practice Address - Zip Code:21713-1236
Practice Address - Country:US
Practice Address - Phone:301-432-4940
Practice Address - Fax:301-432-1120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOONSBORO WELLNESS CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-31
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR101295163W00000X
MDU00399171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty