Healthcare Provider Details

I. General information

NPI: 1093106288
Provider Name (Legal Business Name): ACUPUNCTURE ALCHEMIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 05/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 12TH AVE S
GREAT FALLS MT
59405-4607
US

IV. Provider business mailing address

P.O.BOX 162
GREAT FALLS MT
59403-0162
US

V. Phone/Fax

Practice location:
  • Phone: 406-452-5324
  • Fax: 406-453-8887
Mailing address:
  • Phone: 406-761-3808
  • Fax: 406-453-8887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3446
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number246
License Number StateMT

VIII. Authorized Official

Name: MS. JENNIFER M HOLLOMAN
Title or Position: ACUPUNCTURIST, MASSAGE THERAPIST
Credential: L.AC, LMT
Phone: 406-761-3808