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General NPI Number Information
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NPI Number | 1881052017
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Entity Type | Organization
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Legal Business Name | KISH PAIN AND PERFORMANCE SOLUTIONS
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Dates
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Enumeration Date | 02/02/2016
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Last Update Date | 02/02/2016
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Provider Practice Location Address
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Address Line | 1103 4TH AVE SE
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City | ROCHESTER
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State | MN
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Zip | 55904-7470
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Country | US
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Telephone | 507-261-5439
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Fax |
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Provider Business Mailing Address
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Address Line | 1103 4TH AVE SE
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City | ROCHESTER
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State | MN
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Zip | 55904-7470
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Country | US
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Telephone | 507-261-5439
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Fax |
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Authorized Official
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Title or Position | ACUUPNCTURIST
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Name | MR. PHILIP DANE KISH
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Credential | L.AC. M.AC. DIPL. AC
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Telephone | 507-261-5439
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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 | 1580
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License Number State | MN
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