Healthcare Provider Details

I. General information

NPI: 1003158940
Provider Name (Legal Business Name): ISTHMUS ACUPUNCTURE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 W WINGRA DR
MADISON WI
53715-1942
US

IV. Provider business mailing address

890 W WINGRA DR
MADISON WI
53715-1942
US

V. Phone/Fax

Practice location:
  • Phone: 608-441-9355
  • Fax: 608-441-9395
Mailing address:
  • Phone: 608-441-9355
  • Fax: 608-441-9395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number328-055
License Number StateWI

VIII. Authorized Official

Name: MRS. MICHELLE SUZY BUCHANAN
Title or Position: OWNER, ACUPUNCTURIST
Credential: CA
Phone: 608-441-9355