Healthcare Provider Details

I. General information

NPI: 1265077192
Provider Name (Legal Business Name): FOUR SEAS ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 E MOUNT AIRY AVE
PHILADELPHIA PA
19119-1114
US

IV. Provider business mailing address

3359 BRYAN CT
BENSALEM PA
19020-1814
US

V. Phone/Fax

Practice location:
  • Phone: 610-331-7117
  • Fax: 267-966-3629
Mailing address:
  • Phone: 610-331-7117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNULL

VIII. Authorized Official

Name: INE JONES
Title or Position: CEO
Credential: L.AC.
Phone: 610-331-7117