Healthcare Provider Details

I. General information

NPI: 1770355760
Provider Name (Legal Business Name): FAMILY TREE ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 E 82ND ST STE 310
BLOOMINGTON MN
55425-1683
US

IV. Provider business mailing address

2626 E 82ND ST STE 310
BLOOMINGTON MN
55425-1683
US

V. Phone/Fax

Practice location:
  • Phone: 612-805-8131
  • Fax:
Mailing address:
  • Phone: 612-805-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEFANIE BENIEK
Title or Position: LICENSED ACUPUNCTURIST/OWNER
Credential: L.AC.
Phone: 612-805-8131