Healthcare Provider Details

I. General information

NPI: 1508033523
Provider Name (Legal Business Name): ESKELSON ENTERPRISE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 E RIVER RD
ANOKA MN
55303-2828
US

IV. Provider business mailing address

710 E RIVER RD
ANOKA MN
55303-2828
US

V. Phone/Fax

Practice location:
  • Phone: 763-421-2807
  • Fax: 763-712-3231
Mailing address:
  • Phone: 763-421-2807
  • Fax: 763-712-3231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1524
License Number StateMN

VIII. Authorized Official

Name: KATHY JEAN ESKELSON
Title or Position: PRESIDENT
Credential: LMT
Phone: 763-421-2807