Provider Demographics
NPI:1033703244
Name:MINNESOTA INTEGRATIVE MEDICINE & ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:MINNESOTA INTEGRATIVE MEDICINE & ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:KIERSTIN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC , MSOM
Authorized Official - Phone:651-329-6815
Mailing Address - Street 1:4169 RUSTIC PL
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-6250
Mailing Address - Country:US
Mailing Address - Phone:651-329-6815
Mailing Address - Fax:
Practice Address - Street 1:3818 COON RAPIDS BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2517
Practice Address - Country:US
Practice Address - Phone:651-272-7998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty