Provider Demographics
NPI:1881076438
Name:CORIE TAPPIN L.AC ACUPUNCTURE & TRADITIONAL CHINESE MEDICINE
Entity type:Organization
Organization Name:CORIE TAPPIN L.AC ACUPUNCTURE & TRADITIONAL CHINESE MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:CORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAPPIN
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:310-709-2536
Mailing Address - Street 1:23440 CIVIC CENTER WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4854
Mailing Address - Country:US
Mailing Address - Phone:310-317-9500
Mailing Address - Fax:310-317-9502
Practice Address - Street 1:23440 CIVIC CENTER WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4854
Practice Address - Country:US
Practice Address - Phone:310-317-9500
Practice Address - Fax:310-317-9502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty