Provider Demographics
NPI:1720326879
Name:TRANSFORMATIONAL ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:TRANSFORMATIONAL ACUPUNCTURE LLC
Other - Org Name:UPTOWN ACUPUNCTURE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:DEWALD
Authorized Official - Last Name:MIRAMON
Authorized Official - Suffix:
Authorized Official - Credentials:DACM, DIPLAC, LAC
Authorized Official - Phone:202-297-7404
Mailing Address - Street 1:1645 CONNECTICUT AVENUE NW, 3RD FLOOR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-1054
Mailing Address - Country:US
Mailing Address - Phone:202-297-7404
Mailing Address - Fax:202-478-2633
Practice Address - Street 1:1645 CONNECTICUT AVENUE NW, 3RD FLOOR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-1054
Practice Address - Country:US
Practice Address - Phone:202-297-7404
Practice Address - Fax:202-478-2633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCAC500161171100000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty