Provider Demographics
NPI:1528350576
Name:RAPID CITY ACUPUNCTURE LLC
Entity type:Organization
Organization Name:RAPID CITY ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:605-415-8739
Mailing Address - Street 1:2720 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8128
Mailing Address - Country:US
Mailing Address - Phone:605-791-4001
Mailing Address - Fax:605-791-4001
Practice Address - Street 1:2720 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8128
Practice Address - Country:US
Practice Address - Phone:605-791-4001
Practice Address - Fax:605-791-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01246171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty