Healthcare Provider Details

I. General information

NPI: 1861899726
Provider Name (Legal Business Name): STEVENS POINT ACUPUNCTURE AND ORIENTAL MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 FRANCIS ST
STEVENS POINT WI
54481-5211
US

IV. Provider business mailing address

1034 FRANCIS ST
STEVENS POINT WI
54481-5211
US

V. Phone/Fax

Practice location:
  • Phone: 715-342-5757
  • Fax:
Mailing address:
  • Phone: 715-342-5757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number556-055
License Number StateWI

VIII. Authorized Official

Name: CHERYL DAWN MELTZER
Title or Position: OWNER
Credential:
Phone: 715-342-5757