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General NPI Number Information
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NPI Number | 1477063352
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Entity Type | Organization
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Legal Business Name | THREE MOONS ACUPUNCTURE, LLC
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Dates
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Enumeration Date | 10/05/2017
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Last Update Date | 10/05/2017
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Provider Practice Location Address
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Address Line | 310 OLD GREEN BAY RD
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City | KENOSHA
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State | WI
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Zip | 53144-1125
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Country | US
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Telephone | 262-977-8793
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Fax | 262-997-1327
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Provider Business Mailing Address
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Address Line | 3708 ASTORIA DR
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City | RACINE
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State | WI
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Zip | 53402-3308
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Country | US
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Telephone | 262-977-8793
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Fax | 262-997-1327
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Authorized Official
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Title or Position | OWNER / MEMBER
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Name | KIMBERLY MARIE FILKINS
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Credential | L.AC.
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Telephone | 262-977-8793
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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 | 839-55
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License Number State | WI
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