Provider Demographics
NPI:1992216253
Name:KINNUNEN, KRYSTAL (LAC)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:KINNUNEN
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 1:14 LOOKOUT RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-3238
Mailing Address - Country:US
Mailing Address - Phone:828-301-7166
Mailing Address - Fax:
Practice Address - Street 1:14 LOOKOUT RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-3238
Practice Address - Country:US
Practice Address - Phone:828-301-7166
Practice Address - Fax:828-301-7166
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC794171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty