Provider Demographics
NPI:1952819674
Name:FAULWELL ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:FAULWELL ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:SAID
Authorized Official - Last Name:FAULWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:805-404-0361
Mailing Address - Street 1:59 ELM ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-2047
Mailing Address - Country:US
Mailing Address - Phone:805-404-0361
Mailing Address - Fax:203-909-6176
Practice Address - Street 1:59 ELM ST STE 100
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2047
Practice Address - Country:US
Practice Address - Phone:805-404-0361
Practice Address - Fax:203-909-6176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT714171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty