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General NPI Number Information
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NPI Number | 1821430661
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Entity Type | Organization
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Legal Business Name | ESSENTIALS 4 LIFE, LLC
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Dates
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Enumeration Date | 07/22/2013
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 670 COMMERCE DR SUITE 100
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City | WOODBURY
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State | MN
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Zip | 55125-9206
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Country | US
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Telephone | 651-491-5272
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Fax |
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Provider Business Mailing Address
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Address Line | 9377 WENTLOCK RD
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City | WOODBURY
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State | MN
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Zip | 55125-3419
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Country | US
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Telephone | 651-491-5272
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Fax |
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Authorized Official
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Title or Position | DIPLOMATE IN ACUPUNCTURE
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Name | DARLA A ERICKSON
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Credential | DIPL. AC.
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Telephone | 651-491-5272
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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 | 1478
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License Number State | MN
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