Provider Demographics
NPI:1629304720
Name:RED CRICKET ACUPUNCTURE, L.L.C.
Entity Type:Organization
Organization Name:RED CRICKET ACUPUNCTURE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOI
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DIPLOM
Authorized Official - Phone:612-824-0037
Mailing Address - Street 1:4808 NICOLLET AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-5511
Mailing Address - Country:US
Mailing Address - Phone:612-824-0037
Mailing Address - Fax:612-824-0167
Practice Address - Street 1:4808 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-5511
Practice Address - Country:US
Practice Address - Phone:612-824-0037
Practice Address - Fax:612-824-0167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1424171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty