MEDICARE: FUNCTION 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	1693	MN

General Provider Information

NPI Number	:	1235568395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUNCTION LLC

Provider Business Mailing Address
First Line	:	3546 DAKOTA AVE S
Second Line	:	SUITE B
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55416-2313
Country	:	US
Telephone Number	:	952-417-6433
Fax Number	:

Provider Business Practice Location Address
First Line	:	3546 DAKOTA AVE S
Second Line	:	SUITE B
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55416-2313
Country	:	US
Telephone Number	:	952-417-6433
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW RAAK
Credential	:	L.AC., CMT
Telephone Number	:	612-229-0236

Provider Enumeration Date	:	11/08/2013
Last Update Date	:	11/08/2013

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