Provider Demographics
NPI:1265070320
Name:BLUE HOUSE ACUPUNCTURE, LLC
Entity type:Organization
Organization Name:BLUE HOUSE ACUPUNCTURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:240-813-0024
Mailing Address - Street 1:7525 8TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1813
Mailing Address - Country:US
Mailing Address - Phone:202-309-4958
Mailing Address - Fax:
Practice Address - Street 1:20528 BOLAND FARM RD STE 105
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4032
Practice Address - Country:US
Practice Address - Phone:240-813-0024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty