Healthcare Provider Details

I. General information

NPI: 1124538889
Provider Name (Legal Business Name): JULIENNE ELAINE BECKER LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 KINGWOOD ST STE 119
BRAINERD MN
56401-3400
US

IV. Provider business mailing address

1001 KINGWOOD ST STE 119
BRAINERD MN
56401-3400
US

V. Phone/Fax

Practice location:
  • Phone: 218-821-0062
  • Fax:
Mailing address:
  • Phone: 218-821-0062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberLAC-942
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: