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General NPI Number Information
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NPI Number | 1841367414
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Entity Type | Organization
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Legal Business Name | EAST WEST CLINIC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 5770 W BALD EAGLE BLVD
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-6440
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Country | US
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Telephone | 651-429-9595
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Fax | 651-429-9595
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Provider Business Mailing Address
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Address Line | 5770 W BALD EAGLE BLVD
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-6440
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Country | US
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Telephone | 651-429-9595
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Fax | 651-429-9595
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Authorized Official
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Title or Position | OWNER
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Name | MS. COLET STELLA LAHOZ
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Credential | L.AC. RN
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Telephone | 651-429-9595
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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 | 1013
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License Number State | MN
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