Provider Demographics
NPI:1780402628
Name:CONCORD CENTER ACUPUNCTURE AND HERBAL MEDICINE LLC
Entity type:Organization
Organization Name:CONCORD CENTER ACUPUNCTURE AND HERBAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:N
Authorized Official - Last Name:SOUCY
Authorized Official - Suffix:
Authorized Official - Credentials:LIC AC
Authorized Official - Phone:978-369-9400
Mailing Address - Street 1:676 ELM ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2134
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:676 ELM ST STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2134
Practice Address - Country:US
Practice Address - Phone:978-369-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty