Provider Demographics
NPI:1497187009
Name:BODHI TREE ACUPUNCTURE AND WELLNESS
Entity Type:Organization
Organization Name:BODHI TREE ACUPUNCTURE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPIETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-721-8101
Mailing Address - Street 1:343 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1145
Mailing Address - Country:US
Mailing Address - Phone:262-721-8101
Mailing Address - Fax:
Practice Address - Street 1:343 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1145
Practice Address - Country:US
Practice Address - Phone:262-721-8101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI757-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty