Provider Demographics
NPI:1801304878
Name:REGROWTH INTEGRATIVE ACUPUNCTURE
Entity type:Organization
Organization Name:REGROWTH INTEGRATIVE ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MITTICA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DIPL
Authorized Official - Phone:610-825-5282
Mailing Address - Street 1:2 SCARLET OAK DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-2409
Mailing Address - Country:US
Mailing Address - Phone:610-825-5282
Mailing Address - Fax:
Practice Address - Street 1:2 SCARLET OAK DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-2409
Practice Address - Country:US
Practice Address - Phone:610-825-5282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001092171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty