Provider Demographics
NPI:1114366051
Name:JADE CLOUD
Entity Type:Organization
Organization Name:JADE CLOUD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:RHEA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DYKOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DIPLOM
Authorized Official - Phone:651-214-5525
Mailing Address - Street 1:24000 HIGHWAY 7
Mailing Address - Street 2:SUITE 220
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-2939
Mailing Address - Country:US
Mailing Address - Phone:651-214-5525
Mailing Address - Fax:
Practice Address - Street 1:24000 HIGHWAY 7
Practice Address - Street 2:SUITE 220
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-2939
Practice Address - Country:US
Practice Address - Phone:651-214-5525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1618171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty