Provider Demographics
NPI:1750620845
Name:ACUPUNCTURE FOR ATHLETES INC
Entity type:Organization
Organization Name:ACUPUNCTURE FOR ATHLETES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:773-386-5843
Mailing Address - Street 1:850 S GREENVILLE AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5090
Mailing Address - Country:US
Mailing Address - Phone:972-669-1346
Mailing Address - Fax:
Practice Address - Street 1:850 S GREENVILLE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5090
Practice Address - Country:US
Practice Address - Phone:972-669-1346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01415171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty