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General NPI Number Information
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NPI Number | 1356014781
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Entity Type | Organization
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Legal Business Name | CENTER LIFE HEALTH LLC
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Dates
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Enumeration Date | 07/30/2021
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Last Update Date | 07/30/2021
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Provider Practice Location Address
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Address Line | 204 HARRISON ST
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City | IRONWOOD
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State | MI
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Zip | 49938-1776
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Country | US
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Telephone | 906-285-7015
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Fax |
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Provider Business Mailing Address
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Address Line | 104 E HARDING AVE
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City | IRONWOOD
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State | MI
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Zip | 49938-1216
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Country | US
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Telephone | 651-491-4602
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIERSTIN ANDRESEN
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Credential | LAC
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Telephone | 651-491-4602
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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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