Provider Demographics
NPI:1295038008
Name:LUCKY CAT ACUPUNCTURE AND HERBAL MEDICINE
Entity Type:Organization
Organization Name:LUCKY CAT ACUPUNCTURE AND HERBAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:NOELLE
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MAOM, DIPLOM
Authorized Official - Phone:651-216-3057
Mailing Address - Street 1:3541 LYNDALE AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-4159
Mailing Address - Country:US
Mailing Address - Phone:612-824-1829
Mailing Address - Fax:
Practice Address - Street 1:3541 LYNDALE AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4159
Practice Address - Country:US
Practice Address - Phone:612-824-1829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1436171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty