Provider Demographics
NPI:1255882197
Name:SLOW DOWN AND LIVE ACUPUNCTURE
Entity type:Organization
Organization Name:SLOW DOWN AND LIVE ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST, CRNP
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MAC, CRNP
Authorized Official - Phone:410-849-3456
Mailing Address - Street 1:115 ANNAPOLIS ST
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1309
Mailing Address - Country:US
Mailing Address - Phone:410-849-3456
Mailing Address - Fax:
Practice Address - Street 1:115 ANNAPOLIS ST
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1309
Practice Address - Country:US
Practice Address - Phone:410-849-3456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-15
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR059526261QM2500X
MDU01487261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty