Healthcare Provider Details

I. General information

NPI: 1508649039
Provider Name (Legal Business Name): MINNESOTA INTEGRATIVE HEALTH STUDIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 2ND ST NE
MINNEAPOLIS MN
55413-1130
US

IV. Provider business mailing address

1224 2ND ST NE
MINNEAPOLIS MN
55413-1130
US

V. Phone/Fax

Practice location:
  • Phone: 612-345-5648
  • Fax:
Mailing address:
  • Phone: 612-345-5648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. SAID ISAYED
Title or Position: TRADITIONAL CHINESE MEDICINE DOCTOR
Credential: TCMD
Phone: 763-360-2256