Provider Demographics
NPI:1902564628
Name:MANIFEST HEALTH & WELLNESS ACUPUNCTURE, INC.
Entity Type:Organization
Organization Name:MANIFEST HEALTH & WELLNESS ACUPUNCTURE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KOLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DURRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DACM, LAC
Authorized Official - Phone:858-333-7907
Mailing Address - Street 1:1443 GOLDEN GATE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-1138
Mailing Address - Country:US
Mailing Address - Phone:619-550-6461
Mailing Address - Fax:
Practice Address - Street 1:4501 MISSION BAY DR STE 2D
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4925
Practice Address - Country:US
Practice Address - Phone:858-333-7907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty