Provider Demographics
NPI:1093106288
Name:ACUPUNCTURE ALCHEMIST
Entity Type:Organization
Organization Name:ACUPUNCTURE ALCHEMIST
Other - Org Name:ASPEN ACUPUNCTURE AND INTEGRATIVE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACUPUNCTURIST, MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLLOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, LMT
Authorized Official - Phone:406-761-3808
Mailing Address - Street 1:P.O.BOX 162
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-0162
Mailing Address - Country:US
Mailing Address - Phone:406-761-3808
Mailing Address - Fax:406-453-8887
Practice Address - Street 1:1308 12TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4607
Practice Address - Country:US
Practice Address - Phone:406-452-5324
Practice Address - Fax:406-453-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT246171100000X
MT3446225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty