Provider Demographics
NPI:1255739629
Name:HEALING RIVERS ACUPUNCTURE AND COMMUNITY CENTER
Entity type:Organization
Organization Name:HEALING RIVERS ACUPUNCTURE AND COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:CELESTE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:830-627-1111
Mailing Address - Street 1:1110 W SAN ANTONIO ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-5510
Mailing Address - Country:US
Mailing Address - Phone:830-627-1111
Mailing Address - Fax:
Practice Address - Street 1:1110 W SAN ANTONIO ST
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-5510
Practice Address - Country:US
Practice Address - Phone:830-627-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1530171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty