Provider Demographics
NPI:1740001197
Name:CANOPY HEALING CENTER AND ACUPUNCTURE CLINIC INC.
Entity type:Organization
Organization Name:CANOPY HEALING CENTER AND ACUPUNCTURE CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-640-2033
Mailing Address - Street 1:2621 KENNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-1826
Mailing Address - Country:US
Mailing Address - Phone:818-640-2033
Mailing Address - Fax:
Practice Address - Street 1:336 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3125
Practice Address - Country:US
Practice Address - Phone:818-640-2033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty