Provider Demographics
NPI:1649446618
Name:SUN & MOON ACUPUNCTURE CLINIC INC
Entity type:Organization
Organization Name:SUN & MOON ACUPUNCTURE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:360-577-8989
Mailing Address - Street 1:1717 OLYMPIA WAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632
Mailing Address - Country:US
Mailing Address - Phone:360-577-8989
Mailing Address - Fax:360-577-8985
Practice Address - Street 1:1717 OLYMPIA WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632
Practice Address - Country:US
Practice Address - Phone:360-577-8989
Practice Address - Fax:360-577-8985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty