Provider Demographics
NPI:1740665157
Name:ACUPUNCTURE CLINIC OF TACOMA
Entity type:Organization
Organization Name:ACUPUNCTURE CLINIC OF TACOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNTURIST-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ONICA
Authorized Official - Middle Name:I
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, EAMP
Authorized Official - Phone:253-572-1050
Mailing Address - Street 1:722 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4138
Mailing Address - Country:US
Mailing Address - Phone:253-572-1050
Mailing Address - Fax:253-627-7909
Practice Address - Street 1:722 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4138
Practice Address - Country:US
Practice Address - Phone:253-572-1050
Practice Address - Fax:253-627-7909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000388171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty