Provider Demographics
NPI:1548816226
Name:AMAZON GROVE LLC
Entity type:Organization
Organization Name:AMAZON GROVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DOM, MAC
Authorized Official - Phone:410-705-0660
Mailing Address - Street 1:9552 JOEY DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2455
Mailing Address - Country:US
Mailing Address - Phone:410-705-0660
Mailing Address - Fax:
Practice Address - Street 1:8600 FOUNDRY STREET
Practice Address - Street 2:CARDING BUILDING STE 304
Practice Address - City:SAVAGE
Practice Address - State:MD
Practice Address - Zip Code:20763
Practice Address - Country:US
Practice Address - Phone:410-705-0660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-17
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty