Provider Demographics
NPI:1831535657
Name:RED DRAGON ACUPUNCTURE LLC
Entity type:Organization
Organization Name:RED DRAGON ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:W
Authorized Official - Last Name:GAROFALO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:262-822-4844
Mailing Address - Street 1:5605 WASHINGTON AVE
Mailing Address - Street 2:STE 8F
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4056
Mailing Address - Country:US
Mailing Address - Phone:262-822-4844
Mailing Address - Fax:
Practice Address - Street 1:5605 WASHINGTON AVE
Practice Address - Street 2:STE 8F
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4056
Practice Address - Country:US
Practice Address - Phone:262-822-4844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI732-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty