Healthcare Provider Details

I. General information

NPI: 1245015650
Provider Name (Legal Business Name): DRAGONFLY ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11235 DAVENPORT ST STE 106
OMAHA NE
68154-2690
US

IV. Provider business mailing address

11235 DAVENPORT ST STE 106
OMAHA NE
68154-2690
US

V. Phone/Fax

Practice location:
  • Phone: 402-980-0838
  • Fax: 833-939-3518
Mailing address:
  • Phone: 402-980-0838
  • Fax: 833-939-3518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KIMBERLY HAKOLA
Title or Position: OFFICE MANAGER
Credential: LAC, LMT
Phone: 402-980-0838