Provider Demographics
NPI:1841538808
Name:WHITE DANDELION CHINESE MEDICINE L.L.C.
Entity type:Organization
Organization Name:WHITE DANDELION CHINESE MEDICINE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIKA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:507-301-6565
Mailing Address - Street 1:307 WOODLEY ST W
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2741
Mailing Address - Country:US
Mailing Address - Phone:507-301-6565
Mailing Address - Fax:
Practice Address - Street 1:108 3RD ST E
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2050
Practice Address - Country:US
Practice Address - Phone:507-222-0746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-27
Last Update Date:2013-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1597261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty