Healthcare Provider Details

I. General information

NPI: 1952743221
Provider Name (Legal Business Name): EMPOWERED WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 4TH ST
BOULDER CO
80304-3966
US

IV. Provider business mailing address

8584 BOULDER HILLS DR
LONGMONT CO
80503-8866
US

V. Phone/Fax

Practice location:
  • Phone: 303-499-9224
  • Fax:
Mailing address:
  • Phone: 303-667-0557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number0001877
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number0001877
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0001877
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number0001877
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number0001877
License Number StateCO
# 6
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0001877
License Number StateCO

VIII. Authorized Official

Name: MARGARET CLAIRE HAMPTON
Title or Position: OWNER
Credential: L.AC., DIPL. OM,
Phone: 303-667-0557