Healthcare Provider Details

I. General information

NPI: 1396213658
Provider Name (Legal Business Name): WIND POINT ACUPUNCTURE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 N MAIN ST STE 106
RACINE WI
53402-3121
US

IV. Provider business mailing address

4060 N MAIN ST STE 106
RACINE WI
53402-3121
US

V. Phone/Fax

Practice location:
  • Phone: 262-635-0525
  • Fax: 262-639-0524
Mailing address:
  • Phone: 262-635-0525
  • Fax: 262-639-0524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEPHANIE LYNN SMITH-WHYBARK
Title or Position: SOLE MEMBER LLC
Credential: RN, L.AC
Phone: 262-635-0525