Provider Demographics
NPI:1861861387
Name:KEIPE, LYNDA L (CA, DIPL AC)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:L
Last Name:KEIPE
Suffix:
Gender:F
Credentials:CA, DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 NEW PINERY RD STE B
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-9292
Mailing Address - Country:US
Mailing Address - Phone:608-742-2591
Mailing Address - Fax:
Practice Address - Street 1:2910 NEW PINERY RD STE B
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-9292
Practice Address - Country:US
Practice Address - Phone:608-742-2591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI410-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist