Provider Demographics
NPI:1821496969
Name:EICHMILLER, LEAH (LAC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:EICHMILLER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 3RD ST
Mailing Address - Street 2:SUITE #9
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3271
Mailing Address - Country:US
Mailing Address - Phone:651-797-6440
Mailing Address - Fax:
Practice Address - Street 1:2183 3RD STREET
Practice Address - Street 2:C/O INDULGE SALON
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110
Practice Address - Country:US
Practice Address - Phone:651-797-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1716171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist