Provider Demographics
NPI:1144657974
Name:LAKEWOOD RANCH ACUPUNCTURE AND WELLNESS
Entity type:Organization
Organization Name:LAKEWOOD RANCH ACUPUNCTURE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:AP, DOM
Authorized Official - Phone:941-518-6237
Mailing Address - Street 1:11061 GATEWOOD DR
Mailing Address - Street 2:UNIT 103
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-4943
Mailing Address - Country:US
Mailing Address - Phone:941-518-6237
Mailing Address - Fax:
Practice Address - Street 1:11061 GATEWOOD DR
Practice Address - Street 2:UNIT 103
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-4943
Practice Address - Country:US
Practice Address - Phone:941-518-6237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-12
Last Update Date:2013-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3078171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty