1003426644 NPI number — JUPITER ACUPUNCTURE

Table of content: (NPI 1003426644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003426644 NPI number — JUPITER ACUPUNCTURE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUPITER ACUPUNCTURE
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:
1003426644
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
278 SEABREEZE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33477-6438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-243-8261
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
725 N HIGHWAY A1A STE E108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JUPITER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33477-9514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-730-2585
Provider Business Practice Location Address Fax Number:
561-264-8828
Provider Enumeration Date:
08/07/2020

Additional Information

Authorized Official

Authorized Official Last Name:
ZARLING
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
VERNON
Authorized Official Title or Position:
ACUPUNCTURIST
Authorized Official Telephone Number:
561-730-2585

Provider Taxonomy Codes

  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AP4143 . This is a "ACUPUNCTURE LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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