Provider Demographics
NPI:1679136071
Name:ROCKY MOUNTAIN ACUPUNCTURE AND CHINESE MEDICINE LLC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN ACUPUNCTURE AND CHINESE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:SETH
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:303-386-3559
Mailing Address - Street 1:7878 W 80TH PL STE 2A
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-2573
Mailing Address - Country:US
Mailing Address - Phone:303-386-3559
Mailing Address - Fax:
Practice Address - Street 1:7878 W 80TH PL STE 2A
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-2573
Practice Address - Country:US
Practice Address - Phone:303-386-3559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-21
Last Update Date:2019-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1818OtherDORA