Provider Demographics
NPI:1295174191
Name:ACUPUNCTURE FUNCTIONAL MEDICINE & CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:ACUPUNCTURE FUNCTIONAL MEDICINE & CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:AFSHARI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-951-7666
Mailing Address - Street 1:500 STATE ROAD 436 STE 2080
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5343
Mailing Address - Country:US
Mailing Address - Phone:407-951-7666
Mailing Address - Fax:407-951-7666
Practice Address - Street 1:500 STATE ROAD 436 STE 2080
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5343
Practice Address - Country:US
Practice Address - Phone:407-951-7666
Practice Address - Fax:407-951-7666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL12000038623261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center