1801291653 NPI number — PEG PROCTOR ACUPUNCTURE, LLC

Table of content: (NPI 1801291653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801291653 NPI number — PEG PROCTOR ACUPUNCTURE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEG PROCTOR ACUPUNCTURE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801291653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10055 W DARTMOUTH AVE
Provider Second Line Business Mailing Address:
UNIT 206
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80227-5627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-240-8314
Provider Business Mailing Address Fax Number:
303-423-2536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2150 S BELLAIRE ST
Provider Second Line Business Practice Location Address:
UNIT B 201
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80222-4937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-240-8314
Provider Business Practice Location Address Fax Number:
303-423-2536
Provider Enumeration Date:
10/22/2014

Additional Information

Authorized Official

Authorized Official Last Name:
PROCTOR
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
517-240-8314

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X , with the licence number:  1986 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1023434206 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com