Provider Demographics
NPI:1356061642
Name:TIDEWATER ACUPUNCTURE LLC
Entity type:Organization
Organization Name:TIDEWATER ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:ZEIGLER
Authorized Official - Suffix:
Authorized Official - Credentials:MAC
Authorized Official - Phone:202-744-5480
Mailing Address - Street 1:58 MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MA
Mailing Address - Zip Code:01929-1256
Mailing Address - Country:US
Mailing Address - Phone:202-744-5480
Mailing Address - Fax:
Practice Address - Street 1:13 ELM ST STE 1B
Practice Address - Street 2:
Practice Address - City:MANCHESTER BY THE SEA
Practice Address - State:MA
Practice Address - Zip Code:01944-1366
Practice Address - Country:US
Practice Address - Phone:202-744-5480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty