Provider Demographics
NPI:1932403763
Name:RED CLOVER CLINIC INC
Entity Type:Organization
Organization Name:RED CLOVER CLINIC INC
Other - Org Name:RED CLOVER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TEIGEN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:612-308-3597
Mailing Address - Street 1:2233 HAMLINE AVE N
Mailing Address - Street 2:SUITE 433
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-5005
Mailing Address - Country:US
Mailing Address - Phone:612-308-3597
Mailing Address - Fax:
Practice Address - Street 1:2233 HAMLINE AVE N
Practice Address - Street 2:SUITE 433
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-5005
Practice Address - Country:US
Practice Address - Phone:612-308-3597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1447171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty