Provider Demographics
NPI:1801073622
Name:ACUPUNCTURE WELLNESS CENTER
Entity type:Organization
Organization Name:ACUPUNCTURE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:817-285-0622
Mailing Address - Street 1:1424 BROWN TRL
Mailing Address - Street 2:SUITE B
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6499
Mailing Address - Country:US
Mailing Address - Phone:817-285-0622
Mailing Address - Fax:
Practice Address - Street 1:1424 BROWN TRL
Practice Address - Street 2:SUITE B
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6499
Practice Address - Country:US
Practice Address - Phone:817-285-0622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00751171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty