Provider Demographics
NPI:1134517410
Name:ACUPUNCTURE QUEEN, LLC
Entity Type:Organization
Organization Name:ACUPUNCTURE QUEEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:EICHMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:612-385-5503
Mailing Address - Street 1:2150 3RD ST
Mailing Address - Street 2:SUITE #9
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3271
Mailing Address - Country:US
Mailing Address - Phone:612-385-5503
Mailing Address - Fax:
Practice Address - Street 1:2150 3RD ST
Practice Address - Street 2:SUITE #9
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3271
Practice Address - Country:US
Practice Address - Phone:612-385-5503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1716171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty