Provider Demographics
NPI:1356682793
Name:ACUPUNCTURE & HOLISTIC HEALTH CENTER
Entity type:Organization
Organization Name:ACUPUNCTURE & HOLISTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOWALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:904-296-9545
Mailing Address - Street 1:4540 SOUTHSIDE BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5488
Mailing Address - Country:US
Mailing Address - Phone:904-296-9545
Mailing Address - Fax:904-296-9547
Practice Address - Street 1:4540 SOUTHSIDE BLVD STE 302
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5488
Practice Address - Country:US
Practice Address - Phone:904-296-9545
Practice Address - Fax:904-296-9547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-11
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 208171100000X
FLME113529208D00000X
225700000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1346488756OtherINDIVIDUAL NPI