MEDICARE: LIFEROOT ACUPUNCTURE & HEALING ARTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist
2	225700000X	Massage Therapist	#MT-18489	AZ
3	225700000X	Massage Therapist	#MT-00211P	AZ
4	225700000X	Massage Therapist	#MT-19959	AZ
5	225700000X	Massage Therapist	#MT-19963	AZ
6	261QM1300X	Multi-Specialty Clinic/Center
7	171100000X	Acupuncturist	0623	AZ

General Provider Information

NPI Number	:	1144621988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFEROOT ACUPUNCTURE & HEALING ARTS, LLC

Provider Business Mailing Address
First Line	:	1601 N TUCSON BLVD STE 14
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-3406
Country	:	US
Telephone Number	:	520-323-7060
Fax Number	:	520-323-6175

Provider Business Practice Location Address
First Line	:	1601 N TUCSON BLVD STE 14
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-3406
Country	:	US
Telephone Number	:	520-323-7060
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	KIMBERLY A KLEIMAN
Credential	:
Telephone Number	:	520-323-7060

Provider Enumeration Date	:	09/11/2014
Last Update Date	:	12/07/2020

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