1861773699 NPI number — WELLSPRING ACUPUNCTURE AND ORIENTAL MEDICINE, PLLC

Table of content: (NPI 1861773699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861773699 NPI number — WELLSPRING ACUPUNCTURE AND ORIENTAL MEDICINE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLSPRING ACUPUNCTURE AND ORIENTAL MEDICINE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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NPI Number Information

NPI Number:
1861773699
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2530 COLORADO AVE
Provider Second Line Business Mailing Address:
SUITE 2A
Provider Business Mailing Address City Name:
DURANGO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81301-4760
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2530 COLORADO AVE
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
DURANGO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81301-4760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-382-0321
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KONIKOWSKI
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
970-382-0321

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  1690 , 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)





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