Provider Demographics
NPI:1902438047
Name:FWC ACU LLC
Entity Type:Organization
Organization Name:FWC ACU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENTON
Authorized Official - Middle Name:
Authorized Official - Last Name:WADSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-496-7472
Mailing Address - Street 1:2621 W WACKERLY ST STE E
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6994
Mailing Address - Country:US
Mailing Address - Phone:989-496-7472
Mailing Address - Fax:
Practice Address - Street 1:2621 W WACKERLY ST STE E
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6994
Practice Address - Country:US
Practice Address - Phone:989-496-7472
Practice Address - Fax:989-633-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-06
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty