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General NPI Number Information
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NPI Number | 1033703244
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Entity Type | Organization
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Legal Business Name | MINNESOTA INTEGRATIVE MEDICINE & ACUPUNCTURE LLC
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Dates
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Enumeration Date | 02/28/2021
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Last Update Date | 02/28/2021
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Provider Practice Location Address
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Address Line | 3818 COON RAPIDS BLVD NW
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City | COON RAPIDS
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State | MN
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Zip | 55433-2517
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Country | US
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Telephone | 651-272-7998
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Fax |
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Provider Business Mailing Address
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Address Line | 4169 RUSTIC PL
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City | SHOREVIEW
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State | MN
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Zip | 55126-6250
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Country | US
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Telephone | 651-329-6815
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSED ACUPUNCTURIST
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Name | KIERSTIN LEIGH OLSON
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Credential | L.AC , MSOM
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Telephone | 651-329-6815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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