Provider Demographics
NPI:1457595159
Name:FOUR PILLAR ACUPUNCTURE
Entity Type:Organization
Organization Name:FOUR PILLAR ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHRISTIE
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED ACUPUNCTURI
Authorized Official - Phone:310-259-7719
Mailing Address - Street 1:12427 CASWELL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-4903
Mailing Address - Country:US
Mailing Address - Phone:310-259-7719
Mailing Address - Fax:
Practice Address - Street 1:12427 CASWELL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-4903
Practice Address - Country:US
Practice Address - Phone:310-259-7719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12746305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization