Healthcare Provider Details

I. General information

NPI: 1396390050
Provider Name (Legal Business Name): ACUPUNCTURE AND CHIROPRACTIC LIMITED, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 SNELLING AVE S
SAINT PAUL MN
55105-1944
US

IV. Provider business mailing address

232 SNELLING AVE S
SAINT PAUL MN
55105-1944
US

V. Phone/Fax

Practice location:
  • Phone: 651-219-4114
  • Fax: 651-393-5916
Mailing address:
  • Phone: 651-219-4114
  • Fax: 651-393-5916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. LEWIS HOLM
Title or Position: OWNER
Credential: DC, L.AC
Phone: 651-219-4114