Provider Demographics
NPI:1245553387
Name:WHITE LILY ACUPUNCTURE LLC
Entity type:Organization
Organization Name:WHITE LILY ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:612-396-5622
Mailing Address - Street 1:18476 KENRICK AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-9288
Mailing Address - Country:US
Mailing Address - Phone:612-396-5622
Mailing Address - Fax:
Practice Address - Street 1:18476 KENRICK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-9288
Practice Address - Country:US
Practice Address - Phone:612-396-5622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN171100000X171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty