Provider Demographics
NPI:1427452994
Name:MERRIAM PARK ACUPUNCTURE
Entity type:Organization
Organization Name:MERRIAM PARK ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:PIVEC
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:651-207-3019
Mailing Address - Street 1:1523 SELBY AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6304
Mailing Address - Country:US
Mailing Address - Phone:651-207-6140
Mailing Address - Fax:
Practice Address - Street 1:1523 SELBY AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6304
Practice Address - Country:US
Practice Address - Phone:651-207-3019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty