Healthcare Provider Details

I. General information

NPI: 1053857359
Provider Name (Legal Business Name): HOLISTIC ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 SILVER ST SUITE 1
WATERVILLE ME
04901-5833
US

IV. Provider business mailing address

PO BOX 303
SOUTH BERWICK ME
03908-0303
US

V. Phone/Fax

Practice location:
  • Phone: 207-400-7721
  • Fax:
Mailing address:
  • Phone: 207-400-7721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC390
License Number StateME

VIII. Authorized Official

Name: ISABEL STREICHHAHN-DEMERS
Title or Position: OWNER
Credential: LI.AC
Phone: 207-400-7721