Provider Demographics
NPI:1669096210
Name:FIRE DRAGON ACUPUNCTURE INC
Entity type:Organization
Organization Name:FIRE DRAGON ACUPUNCTURE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BAJDA
Authorized Official - Middle Name:VALENTINA
Authorized Official - Last Name:WELTY
Authorized Official - Suffix:
Authorized Official - Credentials:EAMP, LMP
Authorized Official - Phone:206-780-6988
Mailing Address - Street 1:PO BOX 10578
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-0578
Mailing Address - Country:US
Mailing Address - Phone:206-227-9768
Mailing Address - Fax:206-686-3385
Practice Address - Street 1:9431 COPPERTOP LOOP NE UNIT 206
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-3728
Practice Address - Country:US
Practice Address - Phone:206-780-6988
Practice Address - Fax:206-686-3385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty