Healthcare Provider Details

I. General information

NPI: 1639234263
Provider Name (Legal Business Name): TOTAL HEALTH CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5178 CENTRAL AVE NE
COLUMBIA HEIGHTS MN
55421
US

IV. Provider business mailing address

5178 CENTRAL AVE NE
COLUMBIA HEIGHTS MN
55421-1825
US

V. Phone/Fax

Practice location:
  • Phone: 763-586-6045
  • Fax: 763-586-1098
Mailing address:
  • Phone: 763-586-6045
  • Fax: 763-586-1098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3900177
License Number StateMN

VIII. Authorized Official

Name: SHAOJIE LU
Title or Position: PRESIDENT
Credential: L.AC
Phone: 763-586-6045