Healthcare Provider Details

I. General information

NPI: 1063560340
Provider Name (Legal Business Name): ELINOR HSU LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 CENEX DR
INVER GROVE HEIGHTS MN
55077-1724
US

IV. Provider business mailing address

19 S 1ST ST APT B1202
MINNEAPOLIS MN
55401-1816
US

V. Phone/Fax

Practice location:
  • Phone: 612-385-3628
  • Fax: 651-552-2672
Mailing address:
  • Phone: 612-385-3628
  • Fax: 651-552-2672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1198
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: