Provider Demographics
NPI:1437673555
Name:THE ACCESSIBLE ACUPUNCTURE INITIATIVE, INC.
Entity type:Organization
Organization Name:THE ACCESSIBLE ACUPUNCTURE INITIATIVE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURE PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:J
Authorized Official - Last Name:CONRIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:AP, DIPL OM
Authorized Official - Phone:321-222-3773
Mailing Address - Street 1:5456 GOLDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-3294
Mailing Address - Country:US
Mailing Address - Phone:321-222-3773
Mailing Address - Fax:
Practice Address - Street 1:9318 E COLONIAL DR STE A15
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-4175
Practice Address - Country:US
Practice Address - Phone:321-222-3773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3717171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty