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General NPI Number Information
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NPI Number | 1487909420
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Entity Type | Individual
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Provider Name | KRISTIN GUNDRUM L.AC.
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Gender | Female
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Dates
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Enumeration Date | 07/16/2012
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 1026 DELTA AVE STE A BLOOMING LOTUS ACUPUNCTURE
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City | CINCINNATI
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State | OH
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Zip | 45208-3164
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Country | US
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Telephone | 513-400-4170
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Fax |
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Provider Business Mailing Address
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Address Line | 7860 WOOSTER PIKE
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City | CINCINNATI
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State | OH
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Zip | 45227-4002
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Country | US
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Telephone | 513-370-4471
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | AC044
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 65.000161
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License Number State | OH
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