Healthcare Provider Details

I. General information

NPI: 1689949158
Provider Name (Legal Business Name): INDY ACUPUNCTURE & HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2012
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6155 N COLLEGE AVE
INDIANAPOLIS IN
46220-1957
US

IV. Provider business mailing address

6155 N COLLEGE AVE
INDIANAPOLIS IN
46220-1957
US

V. Phone/Fax

Practice location:
  • Phone: 317-255-3030
  • Fax: 317-255-3035
Mailing address:
  • Phone: 317-255-3030
  • Fax: 317-255-3035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number84000075A
License Number StateIN

VIII. Authorized Official

Name: MISS ERICA J SIEGEL
Title or Position: LICENSED ACUPUNCTURIST/ PRESIDENT
Credential: L.AC.
Phone: 317-255-3030