Provider Demographics
NPI:1184385585
Name:NORTHERN NECK ACUPUNCTURE LLC
Entity type:Organization
Organization Name:NORTHERN NECK ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:DUMBRA
Authorized Official - Last Name:CLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-812-5544
Mailing Address - Street 1:656 CREEK VIEW LN
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:VA
Mailing Address - Zip Code:22572-3737
Mailing Address - Country:US
Mailing Address - Phone:804-313-9182
Mailing Address - Fax:
Practice Address - Street 1:6553 RICHMOND ROAD
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:VA
Practice Address - Zip Code:22572
Practice Address - Country:US
Practice Address - Phone:804-313-9182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty