Provider Demographics
NPI:1265560361
Name:BETSY MACMACKIN MUNROE INC A PROFESSIONAL ACUPUNCTURE CORP
Entity type:Organization
Organization Name:BETSY MACMACKIN MUNROE INC A PROFESSIONAL ACUPUNCTURE CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT SEC OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:MACMACKIN
Authorized Official - Last Name:MUNROE
Authorized Official - Suffix:
Authorized Official - Credentials:DIPL OM LAC
Authorized Official - Phone:805-563-2972
Mailing Address - Street 1:1110 CRESTLINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105
Mailing Address - Country:US
Mailing Address - Phone:805-563-2972
Mailing Address - Fax:805-563-2972
Practice Address - Street 1:3710 STATE STREET
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105
Practice Address - Country:US
Practice Address - Phone:805-448-2764
Practice Address - Fax:805-563-2972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10958171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty