Provider Demographics
NPI:1932752946
Name:SILK BAMBOO HOLLOW
Entity Type:Organization
Organization Name:SILK BAMBOO HOLLOW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURE PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:954-907-9787
Mailing Address - Street 1:1645 PALM BEACH LAKES BLVD
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401
Mailing Address - Country:US
Mailing Address - Phone:954-907-9787
Mailing Address - Fax:
Practice Address - Street 1:1645 PALM BEACH LAKES BLVD
Practice Address - Street 2:SUITE 1200
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401
Practice Address - Country:US
Practice Address - Phone:954-907-9787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SILK BAMBOO HOLLOW
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty