Provider Demographics
NPI:1982361648
Name:LAKE ACUPUNCTURE LLC
Entity type:Organization
Organization Name:LAKE ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-353-6907
Mailing Address - Street 1:2929 4TH AVE S STE 208
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2465
Mailing Address - Country:US
Mailing Address - Phone:612-353-6907
Mailing Address - Fax:
Practice Address - Street 1:2929 4TH AVE S STE 208
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2465
Practice Address - Country:US
Practice Address - Phone:612-353-6907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty