Organization
MOUNTAIN SAGE ACUPUNCTURE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER INGE ELLSWORTH L.AC. (LICENSED ACUPUNCTURIST/OWNER)
(406) 531-0689
Entity
Organization
Contact information
Practice address
200 E PINE ST, MISSOULA, MT 59802-4513
(406) 531-0689
Mailing address
PO BOX 9153, MISSOULA, MT 59807-9153
(406) 531-0689
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18802
STATE MEDICAL ACUPUNCTURE LICENSE
MT
Enumeration date
10/12/2020
Last updated
10/12/2020
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