Provider Demographics
NPI:1427576727
Name:NE COMMUNITY ACUPUNCTURE & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:NE COMMUNITY ACUPUNCTURE & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIVACY OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:BA, CMT, CST-D
Authorized Official - Phone:612-399-6322
Mailing Address - Street 1:1224 2ND ST NE # 200
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1130
Mailing Address - Country:US
Mailing Address - Phone:612-399-6322
Mailing Address - Fax:
Practice Address - Street 1:1224 2ND ST NE # 200
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1130
Practice Address - Country:US
Practice Address - Phone:612-399-6322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation