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General NPI Number Information
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NPI Number | 1912138561
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Entity Type | Organization
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Legal Business Name | GREEN DRAGON ACUPUNCTURE, INC
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Dates
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Enumeration Date | 07/30/2009
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Last Update Date | 07/30/2009
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Provider Practice Location Address
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Address Line | 12203 ABERDEEN ST NE SUITE 120
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City | BLAINE
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State | MN
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Zip | 55449-5174
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Country | US
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Telephone | 612-414-3250
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Fax |
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Provider Business Mailing Address
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Address Line | 1860 125TH LN NE
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City | BLAINE
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State | MN
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Zip | 55449-4957
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | KIMBERLY FRITZ
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Credential | M.OM., L.AC.
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Telephone | 612-414-3250
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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 |
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License Number State |
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