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General NPI Number Information
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NPI Number | 1831535657
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Entity Type | Organization
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Legal Business Name | RED DRAGON ACUPUNCTURE LLC
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 05/20/2013
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Provider Practice Location Address
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Address Line | 5605 WASHINGTON AVE STE 8F
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City | MOUNT PLEASANT
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State | WI
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Zip | 53406-4056
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Country | US
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Telephone | 262-822-4844
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Fax |
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Provider Business Mailing Address
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Address Line | 5605 WASHINGTON AVE STE 8F
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City | MOUNT PLEASANT
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State | WI
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Zip | 53406-4056
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Country | US
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Telephone | 262-822-4844
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. KEITH W. GAROFALO
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Credential | L.AC.
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Telephone | 262-822-4844
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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 | 732-055
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License Number State | WI
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