Provider Demographics
NPI:1689984833
Name:FROHLICH, NOAH BENJAMIN (LAC,DIPLOM,MAOM)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:BENJAMIN
Last Name:FROHLICH
Suffix:
Gender:M
Credentials:LAC,DIPLOM,MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 2ND ST NE # 2
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1133
Mailing Address - Country:US
Mailing Address - Phone:612-709-5872
Mailing Address - Fax:
Practice Address - Street 1:1224 2ND ST NE STE 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:612-709-5872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1504171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist