Organization
FORMLESS FORM QIGONG & ACUPUNCTURE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PENG RODEN HER LAC (OWNER)
(612) 708-0753
Entity
Organization
Contact information
Practice address
5603 CHICAGO AVE, MINNEAPOLIS, MN 55417-2429
(612) 708-0753
Mailing address
5603 CHICAGO AVE, MINNEAPOLIS, MN 55417-2429
(612) 708-0753
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
1588
MN
Other
Enumeration date
10/22/2012
Last updated
03/01/2018
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