Healthcare Provider Details

I. General information

NPI: 1346545449
Provider Name (Legal Business Name): BLUE LOTUS HEALING ARTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 E 50TH ST
MINNEAPOLIS MN
55417-1337
US

IV. Provider business mailing address

2720 E 50TH ST
MINNEAPOLIS MN
55417-1337
US

V. Phone/Fax

Practice location:
  • Phone: 612-721-0036
  • Fax:
Mailing address:
  • Phone: 612-721-0036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1518
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. BENJAMIN HERSCHEL KATZ
Title or Position: DIRECTOR OF PROGRAMS
Credential: CMT
Phone: 612-590-1443