Provider Demographics
NPI:1457936940
Name:JONES, MICHELLE LYN (LAC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LYN
Last Name:JONES
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 1:9524 DAKOTA RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-1711
Mailing Address - Country:US
Mailing Address - Phone:612-385-5424
Mailing Address - Fax:
Practice Address - Street 1:1925 COUNTY ROAD B2 W
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-2703
Practice Address - Country:US
Practice Address - Phone:651-631-0204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1945171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty