Provider Demographics
NPI:1871966440
Name:INTER-HEALTH ACUPUNCTURE LLC
Entity type:Organization
Organization Name:INTER-HEALTH ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, LCSW
Authorized Official - Phone:317-888-2062
Mailing Address - Street 1:PO BOX 7051
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-6421
Mailing Address - Country:US
Mailing Address - Phone:317-885-1800
Mailing Address - Fax:317-885-1801
Practice Address - Street 1:360 S MADISON AVE STE 108
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-3117
Practice Address - Country:US
Practice Address - Phone:317-885-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000078A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty