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General NPI Number Information
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NPI Number | 1740708262
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Entity Type | Organization
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Legal Business Name | RADIANT NATURAL HEALTH CLINIC SC
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Dates
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Enumeration Date | 09/05/2017
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Last Update Date | 09/05/2017
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Provider Practice Location Address
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Address Line | 619 WASHINGTON AVE
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City | NIAGARA
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State | WI
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Zip | 54151
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Country | US
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Telephone | 715-251-3555
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Fax | 715-251-3559
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Provider Business Mailing Address
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Address Line | PO BOX 243
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City | NIAGARA
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State | WI
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Zip | 54151
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Country | US
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Telephone | 715-251-3555
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Fax | 715-251-3559
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KERRY NIEBRZYDOWSKI
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Credential | ND LAC
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Telephone | 715-251-3555
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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 | 857-55
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License Number State | WI
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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 | 652-55
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License Number State | WI
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