Healthcare Provider Details

I. General information

NPI: 1144621988
Provider Name (Legal Business Name): LIFEROOT ACUPUNCTURE & HEALING ARTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N TUCSON BLVD STE 14
TUCSON AZ
85716-3406
US

IV. Provider business mailing address

1601 N TUCSON BLVD STE 14
TUCSON AZ
85716-3406
US

V. Phone/Fax

Practice location:
  • Phone: 520-323-7060
  • Fax:
Mailing address:
  • Phone: 520-323-7060
  • Fax: 520-323-6175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0623
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number#MT-18489
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number#MT-00211P
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number#MT-19959
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number#MT-19963
License Number StateAZ

VIII. Authorized Official

Name: KIMBERLY A KLEIMAN
Title or Position: PROVIDER
Credential:
Phone: 520-323-7060