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General NPI Number Information
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NPI Number | 1063165843
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Entity Type | Organization
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Legal Business Name | EARTH ELEMENTS ACUPUNCTURE & WELLNESS
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Dates
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Enumeration Date | 02/01/2022
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 136 N 1ST AVE E
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City | ELY
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State | MN
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Zip | 55731-1203
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Country | US
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Telephone | 612-207-3660
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Fax | 218-242-8409
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Provider Business Mailing Address
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Address Line | 1133 E WASHINGTON ST
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City | ELY
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State | MN
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Zip | 55731-1707
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Country | US
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Telephone | 612-207-3660
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARA FETYKO
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Credential | LAC
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Telephone | 612-207-3660
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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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