Provider Demographics
NPI:1396225116
Name:BLUESTEM ACUPUNCTURE CLINIC OF KANSAS LLC
Entity Type:Organization
Organization Name:BLUESTEM ACUPUNCTURE CLINIC OF KANSAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:VESTER-COUCH
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:316-285-8058
Mailing Address - Street 1:505 S BROADWAY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3922
Mailing Address - Country:US
Mailing Address - Phone:316-285-8058
Mailing Address - Fax:
Practice Address - Street 1:505 S BROADWAY AVE STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-3922
Practice Address - Country:US
Practice Address - Phone:316-285-8058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS23-00016171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty