Provider Demographics
NPI:1871980946
Name:CHINESE HOLISTIC HEALTH CENTER LLC
Entity type:Organization
Organization Name:CHINESE HOLISTIC HEALTH CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:YIRAN
Authorized Official - Middle Name:WANG
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:614-657-8695
Mailing Address - Street 1:777 CARLE AVE
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-8293
Mailing Address - Country:US
Mailing Address - Phone:614-657-8695
Mailing Address - Fax:
Practice Address - Street 1:777 CARLE AVE
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-8293
Practice Address - Country:US
Practice Address - Phone:614-657-8695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000283171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH12737397OtherCAQH PROVIDER