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General NPI Number Information
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NPI Number | 1558813840
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Entity Type | Organization
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Legal Business Name | LAKE MILLS ACUPUNCTURE AND WELLNESS
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Dates
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Enumeration Date | 11/02/2016
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | 331 N MAIN ST
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City | LAKE MILLS
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State | WI
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Zip | 53551-1162
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Country | US
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Telephone | 920-239-8585
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Fax | 414-386-7909
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Provider Business Mailing Address
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Address Line | 331 N MAIN ST
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City | LAKE MILLS
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State | WI
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Zip | 53551-1162
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Country | US
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Telephone | 920-239-8585
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Fax | 414-386-7909
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Authorized Official
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Title or Position | LICENSED ACUPUNCTURIST
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Name | DANIELLE LUCIO
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Credential | MSOM LAC
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Telephone | 920-239-8585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 743-55
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License Number State | WI
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