Provider Demographics
NPI:1457681868
Name:GEGEN ACUPUNCTURE
Entity type:Organization
Organization Name:GEGEN ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GEGEN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MS
Authorized Official - Phone:612-720-2779
Mailing Address - Street 1:224 W FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-2331
Mailing Address - Country:US
Mailing Address - Phone:612-720-2779
Mailing Address - Fax:
Practice Address - Street 1:224 W FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2331
Practice Address - Country:US
Practice Address - Phone:612-720-2779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1232171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty