Provider Demographics
NPI:1720321128
Name:JOHN NIETERS, L.AC.
Entity Type:Organization
Organization Name:JOHN NIETERS, L.AC.
Other - Org Name:ALAMEDA ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIETERS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DAOM
Authorized Official - Phone:5108-140-9100
Mailing Address - Street 1:2258 SANTA CLARA AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4473
Mailing Address - Country:US
Mailing Address - Phone:510-814-6900
Mailing Address - Fax:
Practice Address - Street 1:2258 SANTA CLARA AVE STE 1
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4473
Practice Address - Country:US
Practice Address - Phone:510-814-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6599171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty