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NPI Code Detail

MEDICARE: SHELLEY J. CONN L.AC.

MEDICARE: SHELLEY J. CONN L.AC.
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
1171100000XAcupuncturist1254MN

General Provider Information

NPI Number : 1215992540
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELLEY J. CONN L.AC.
Provider Business Mailing Address
First Line : 1824 E MEDICINE LAKE BLVD
Second Line :
City : PLYMOUTH
State : MN
Zip : 55441-4234
Country : US
Telephone Number : 763-546-3762
Fax Number :
Provider Business Practice Location Address
First Line : 5821 CEDAR LAKE RD S
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55416-1487
Country : US
Telephone Number : 952-545-2250
Fax Number : 952-525-1088
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2006
Last Update Date : 07/08/2007

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