Provider Demographics
NPI:1720127582
Name:ACUPUNTURE & WELLNESS CENTER PS
Entity Type:Organization
Organization Name:ACUPUNTURE & WELLNESS CENTER PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DOANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-394-4357
Mailing Address - Street 1:18870 8TH AVE NE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6233
Mailing Address - Country:US
Mailing Address - Phone:360-394-4357
Mailing Address - Fax:360-394-7972
Practice Address - Street 1:18870 8TH AVE NE
Practice Address - Street 2:SUITE 8
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6233
Practice Address - Country:US
Practice Address - Phone:360-394-4357
Practice Address - Fax:360-394-7972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID