Healthcare Provider Details

I. General information

NPI: 1710767298
Provider Name (Legal Business Name): STILL LIFE ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 PIERCE ST
SANTA ROSA CA
95404-6625
US

IV. Provider business mailing address

213 PIERCE ST
SANTA ROSA CA
95404-6625
US

V. Phone/Fax

Practice location:
  • Phone: 707-583-3226
  • Fax:
Mailing address:
  • Phone: 805-458-4506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL STOLPER
Title or Position: CEO/TREASURER/SECRETARY
Credential: L.AC.
Phone: 707-583-3226