Healthcare Provider Details

I. General information

NPI: 1326474842
Provider Name (Legal Business Name): FUNCTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3546 DAKOTA AVE S SUITE B
SAINT LOUIS PARK MN
55416-2313
US

IV. Provider business mailing address

3546 DAKOTA AVE S SUITE B
SAINT LOUIS PARK MN
55416-2313
US

V. Phone/Fax

Practice location:
  • Phone: 612-229-0236
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1653
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANDREW RAAK
Title or Position: CHIEF MANAGER, OWNER
Credential: L.AC., CMT
Phone: 612-229-0236