Healthcare Provider Details

I. General information

NPI: 1134064942
Provider Name (Legal Business Name): RIVER RIDGE ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S 2ND ST STE 20
RIVER FALLS WI
54022-2427
US

IV. Provider business mailing address

215 S 2ND ST STE 20
RIVER FALLS WI
54022-2427
US

V. Phone/Fax

Practice location:
  • Phone: 715-396-1849
  • Fax:
Mailing address:
  • Phone: 715-396-1849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHANE BARTLEY BERQUIST
Title or Position: CEO
Credential: L.AC.
Phone: 715-396-1849