Provider Demographics
NPI:1275180150
Name:MANKATO ACUPUNCTURE CLINIC, LLC
Entity Type:Organization
Organization Name:MANKATO ACUPUNCTURE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HYLLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-388-6829
Mailing Address - Street 1:709 S FRONT ST STE 5
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3887
Mailing Address - Country:US
Mailing Address - Phone:507-388-6829
Mailing Address - Fax:507-388-1963
Practice Address - Street 1:360 PIERCE AVE STE 203
Practice Address - Street 2:
Practice Address - City:NORTH MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56003-2211
Practice Address - Country:US
Practice Address - Phone:507-388-6829
Practice Address - Fax:507-388-1963
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANKATO ACUPUNCTURE CLINIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-24
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty