Provider Demographics
NPI:1679063093
Name:EICHORN, VIRGINIA E (LAC, LMT)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:E
Last Name:EICHORN
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 ROCKY MOUNTAIN PL
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-4027
Mailing Address - Country:US
Mailing Address - Phone:703-939-0207
Mailing Address - Fax:
Practice Address - Street 1:727 ROCKY MOUNTAIN PL
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-4027
Practice Address - Country:US
Practice Address - Phone:703-939-0207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0017598225700000X
COACU.0002088171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist