Healthcare Provider Details

I. General information

NPI: 1518662949
Provider Name (Legal Business Name): KEWEENAW ACUPUNCTURE AND WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 NORTH ELEVATION STREET SUITE 3
HANCOCK MI
49930-1167
US

IV. Provider business mailing address

1101 NORTH ELEVATION STREET SUITE 3
HANCOCK MI
49930-1167
US

V. Phone/Fax

Practice location:
  • Phone: 906-231-3109
  • Fax: 844-965-9113
Mailing address:
  • Phone: 906-231-3109
  • Fax: 844-965-9113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: AMY L BACHHUBER
Title or Position: OWNER/ACUPUNCTURIST
Credential: L.AC.
Phone: 906-231-3109