Provider Demographics
NPI:1023282506
Name:FOUR WINDS ACUPUNCTURE CLINIC AND INTEGRATIVE THERAPIES, PC
Entity type:Organization
Organization Name:FOUR WINDS ACUPUNCTURE CLINIC AND INTEGRATIVE THERAPIES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MANOCCHIO
Authorized Official - Suffix:II
Authorized Official - Credentials:LCSW
Authorized Official - Phone:570-836-7777
Mailing Address - Street 1:6 SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-6950
Mailing Address - Country:US
Mailing Address - Phone:570-836-7777
Mailing Address - Fax:570-836-7479
Practice Address - Street 1:6 SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657
Practice Address - Country:US
Practice Address - Phone:570-836-7777
Practice Address - Fax:570-836-7479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0146681041C0700X
PAAK000898171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty