Provider Demographics
NPI:1811350457
Name:INTUITIVE ACUPUNCTURE
Entity type:Organization
Organization Name:INTUITIVE ACUPUNCTURE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:OLCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:805-459-6561
Mailing Address - Street 1:1025 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3623
Mailing Address - Country:US
Mailing Address - Phone:805-459-6561
Mailing Address - Fax:
Practice Address - Street 1:1025 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3623
Practice Address - Country:US
Practice Address - Phone:805-459-6561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTUITIVE ACUPUNCTURE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-31
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15622171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty