Provider Demographics
NPI:1669750899
Name:ACACIA CHIROPRACTIC AND ACUPUNCTURE P.C.
Entity type:Organization
Organization Name:ACACIA CHIROPRACTIC AND ACUPUNCTURE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-519-3686
Mailing Address - Street 1:3088 FLORA RD
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-9342
Mailing Address - Country:US
Mailing Address - Phone:815-519-3686
Mailing Address - Fax:815-547-5216
Practice Address - Street 1:3088 FLORA RD
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-9342
Practice Address - Country:US
Practice Address - Phone:815-519-3686
Practice Address - Fax:815-547-5216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty