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General NPI Number Information
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NPI Number | 1457681868
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Entity Type | Organization
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Legal Business Name | GEGEN ACUPUNCTURE
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Dates
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Enumeration Date | 01/06/2010
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Last Update Date | 01/06/2010
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Provider Practice Location Address
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Address Line | 224 W FRANKLIN AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-2331
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Country | US
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Telephone | 612-720-2779
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Fax |
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Provider Business Mailing Address
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Address Line | 224 W FRANKLIN AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-2331
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Country | US
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Telephone | 612-720-2779
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. COLLEEN ANN GEGEN
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Credential | L.AC., MS
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Telephone | 612-720-2779
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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 | 1232
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License Number State | MN
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