Provider Demographics
NPI:1336530187
Name:BIRDS NEST ACUPUNCTURE
Entity Type:Organization
Organization Name:BIRDS NEST ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHADWICK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:512-761-6719
Mailing Address - Street 1:4101 MEDICAL PKWY
Mailing Address - Street 2:SUITE 113
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3734
Mailing Address - Country:US
Mailing Address - Phone:512-761-6719
Mailing Address - Fax:
Practice Address - Street 1:4101 MEDICAL PKWY
Practice Address - Street 2:SUITE 113
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3734
Practice Address - Country:US
Practice Address - Phone:512-761-6719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01379171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty