Provider Demographics
NPI:1356759740
Name:MANKATO ACUPUNCTURE CLINIC, LLC
Entity type:Organization
Organization Name:MANKATO ACUPUNCTURE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HYLLA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:507-388-6829
Mailing Address - Street 1:709 S FRONT ST STE 5
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3887
Mailing Address - Country:US
Mailing Address - Phone:507-388-6829
Mailing Address - Fax:507-388-1963
Practice Address - Street 1:709 S FRONT ST STE 5
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3887
Practice Address - Country:US
Practice Address - Phone:507-388-6829
Practice Address - Fax:507-388-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1564171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty