1407113665 NPI number — ORIENTAL BODYWORK & ACUPUNCTURE CLINIC, S.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407113665 NPI number — ORIENTAL BODYWORK & ACUPUNCTURE CLINIC, S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORIENTAL BODYWORK & ACUPUNCTURE CLINIC, S.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407113665
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
313 WEST BELTLINE HWY
Provider Second Line Business Mailing Address:
SUITE # 133
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-716-3771
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
313 WEST BELTLINE HWY
Provider Second Line Business Practice Location Address:
SUITE # 133
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-716-3771
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MASON
Authorized Official First Name:
TERRENCE
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
262-716-3771

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  #160-055 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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