Provider Demographics
NPI:1447372735
Name:ACUPUNCTURE & WELLNESS CLINIC OF RUSKIN, INC
Entity type:Organization
Organization Name:ACUPUNCTURE & WELLNESS CLINIC OF RUSKIN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCHAR HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:813-645-8168
Mailing Address - Street 1:PO BOX 792
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33575-0792
Mailing Address - Country:US
Mailing Address - Phone:813-645-8168
Mailing Address - Fax:
Practice Address - Street 1:205 W SHELL POINT RD
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-3706
Practice Address - Country:US
Practice Address - Phone:813-645-8168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2376171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP2376OtherLICENSE NUMBER