Provider Demographics
NPI:1518280338
Name:TOTAL HEALTH ACUPUNCTURE & HERBAL CLINIC
Entity type:Organization
Organization Name:TOTAL HEALTH ACUPUNCTURE & HERBAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:PROF
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:763-586-6045
Mailing Address - Street 1:1023 E. MOORE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432
Mailing Address - Country:US
Mailing Address - Phone:763-586-6045
Mailing Address - Fax:763-586-1098
Practice Address - Street 1:1023 E. MOORE LAKE DR
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432
Practice Address - Country:US
Practice Address - Phone:763-586-6045
Practice Address - Fax:763-586-1098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1068171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty