Provider Demographics
NPI:1700174794
Name:TWIN CITIES ACUPUNCTURE
Entity Type:Organization
Organization Name:TWIN CITIES ACUPUNCTURE
Other - Org Name:ACUPUNCTURE INSTITUTE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:651-636-0055
Mailing Address - Street 1:1700 HIGHWAY 36 W
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4034
Mailing Address - Country:US
Mailing Address - Phone:651-636-0055
Mailing Address - Fax:651-756-7320
Practice Address - Street 1:1700 HIGHWAY 36 W
Practice Address - Street 2:SUITE 400
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4034
Practice Address - Country:US
Practice Address - Phone:651-636-0055
Practice Address - Fax:651-756-7320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty