Provider Demographics
NPI:1235568395
Name:FUNCTION LLC
Entity Type:Organization
Organization Name:FUNCTION LLC
Other - Org Name:FUNCTION: MASSAGE & ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:RAAK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, CMT
Authorized Official - Phone:612-229-0236
Mailing Address - Street 1:3546 DAKOTA AVE S
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2313
Mailing Address - Country:US
Mailing Address - Phone:952-417-6433
Mailing Address - Fax:
Practice Address - Street 1:3546 DAKOTA AVE S
Practice Address - Street 2:SUITE B
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2313
Practice Address - Country:US
Practice Address - Phone:952-417-6433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1693171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty