Provider Demographics
NPI:1477063352
Name:THREE MOONS ACUPUNCTURE, LLC
Entity Type:Organization
Organization Name:THREE MOONS ACUPUNCTURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:262-977-8793
Mailing Address - Street 1:3708 ASTORIA DR
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-3308
Mailing Address - Country:US
Mailing Address - Phone:262-977-8793
Mailing Address - Fax:262-997-1327
Practice Address - Street 1:310 OLD GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1125
Practice Address - Country:US
Practice Address - Phone:262-977-8793
Practice Address - Fax:262-997-1327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI839-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty