Provider Demographics
NPI:1770771123
Name:ETERNAL SPRING ACUPUNCTURE INC
Entity type:Organization
Organization Name:ETERNAL SPRING ACUPUNCTURE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FEI
Authorized Official - Middle Name:
Authorized Official - Last Name:XIAO
Authorized Official - Suffix:
Authorized Official - Credentials:TCMD
Authorized Official - Phone:651-430-3600
Mailing Address - Street 1:4348 GALTIER ST.
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126
Mailing Address - Country:US
Mailing Address - Phone:651-484-6063
Mailing Address - Fax:
Practice Address - Street 1:14791 60TH ST N
Practice Address - Street 2:SUITE 6
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6382
Practice Address - Country:US
Practice Address - Phone:651-430-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN843D1ETOtherBLUECROSS BLUESHIELD
MNHP34709OtherHEALTHPARTNERS