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General NPI Number Information
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NPI Number | 1336481399
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Entity Type | Organization
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Legal Business Name | HE ACPUNCTURE & HERBAL MEDICINE, LLC
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Dates
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Enumeration Date | 03/18/2013
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Last Update Date | 03/18/2013
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Provider Practice Location Address
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Address Line | 3632 W LAKEFIELD DR
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City | MILWAUKEE
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State | WI
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Zip | 53215-4135
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Country | US
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Telephone | 414-630-7229
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Fax |
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Provider Business Mailing Address
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Address Line | 3632 W LAKEFIELD DR
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City | MILWAUKEE
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State | WI
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Zip | 53215-4135
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Country | US
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Telephone | 414-630-7229
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. HEATHER L ELDRIDGE
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Credential | C.AC, MSOM
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Telephone | 414-630-7229
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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 | 786-55
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License Number State | WI
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