Provider Demographics
NPI:1184883175
Name:ANCIENT HEALING ACUPUNCTURE AND HERBS LLC
Entity type:Organization
Organization Name:ANCIENT HEALING ACUPUNCTURE AND HERBS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:262-880-1442
Mailing Address - Street 1:5748 CAMBRIDGE LN
Mailing Address - Street 2:#8
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-2839
Mailing Address - Country:US
Mailing Address - Phone:262-886-8839
Mailing Address - Fax:
Practice Address - Street 1:1744 22ND AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-1413
Practice Address - Country:US
Practice Address - Phone:262-551-9667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI569-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty