Individual
SIDDHARTHA M. G. HANNIBAL WOLONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC.
Contact information
Practice address
329 E HIGHWAY 12, LITCHFIELD, MN 55355-2295
(320) 699-0161
Mailing address
329 E HIGHWAY 12, LITCHFIELD, MN 55355-2295
(320) 699-6061
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
1695
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1695
STATE OF MN MINNESOTA BOARDS OF MEDICAL PRACTICE
MN
01
—
P146113245311
DRIVERS LICENSE
MN
Enumeration date
12/02/2020
Last updated
12/02/2020
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