Provider Demographics
NPI:1285237016
Name:TCM WELLNESS CLINIC LLC
Entity type:Organization
Organization Name:TCM WELLNESS CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VANECEK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MACOM,
Authorized Official - Phone:612-965-5227
Mailing Address - Street 1:675 WATER ST STE 3
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-3072
Mailing Address - Country:US
Mailing Address - Phone:612-965-5227
Mailing Address - Fax:
Practice Address - Street 1:675 WATER ST STE 3
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-3072
Practice Address - Country:US
Practice Address - Phone:612-965-5227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty