Provider Demographics
NPI:1679292312
Name:JENNUM O'HARA ACUPUNCTURE, LLC
Entity type:Organization
Organization Name:JENNUM O'HARA ACUPUNCTURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNUM
Authorized Official - Middle Name:
Authorized Official - Last Name:O'HARA
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, LAC
Authorized Official - Phone:518-669-2982
Mailing Address - Street 1:8726 TOWN AND COUNTRY BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3061
Mailing Address - Country:US
Mailing Address - Phone:240-319-2694
Mailing Address - Fax:833-579-8626
Practice Address - Street 1:8726 TOWN AND COUNTRY BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3061
Practice Address - Country:US
Practice Address - Phone:240-319-2694
Practice Address - Fax:833-579-8626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty