Provider Demographics
NPI:1770967325
Name:DANCING CRANE CENTER OF CHINESE MEDICINE
Entity type:Organization
Organization Name:DANCING CRANE CENTER OF CHINESE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTINONER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:540-444-1043
Mailing Address - Street 1:11 LIBRARY SQ
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-3846
Mailing Address - Country:US
Mailing Address - Phone:540-444-1053
Mailing Address - Fax:540-444-1054
Practice Address - Street 1:11 LIBRARY SQ
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-3846
Practice Address - Country:US
Practice Address - Phone:540-444-1053
Practice Address - Fax:540-444-1054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000321261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center