Healthcare Provider Details

I. General information

NPI: 1144880378
Provider Name (Legal Business Name): BEYOND ZEN ENTERPRISES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 TOSCANA BLVD
GRANGER IN
46530-8041
US

IV. Provider business mailing address

318 TOSCANA BLVD
GRANGER IN
46530-8041
US

V. Phone/Fax

Practice location:
  • Phone: 574-855-1405
  • Fax:
Mailing address:
  • Phone: 574-855-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MRS. NATALIE MAE KILHEENEY
Title or Position: CEO, ACUPUNCTURIST
Credential: L.AC., DIPL OM
Phone: 475-855-1405