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General NPI Number Information
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NPI Number | 1922486315
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Entity Type | Individual
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Provider Name | TERESA GROTKOPP L.AC.
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Gender | Female
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Dates
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Enumeration Date | 05/18/2015
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Last Update Date | 07/25/2015
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Provider Practice Location Address
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Address Line | 1221 NOBLE ST
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City | FAIRBANKS
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State | AK
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Zip | 99701-4979
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Country | US
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Telephone | 907-456-4234
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Fax |
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Provider Business Mailing Address
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Address Line | SEESTR. 18
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City | HAMBURG
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State | HAMBURG
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Zip | 22607
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Country | DE
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | ACU-160
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License Number State | HI
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