Healthcare Provider Details

I. General information

NPI: 1215280169
Provider Name (Legal Business Name): JOSHUA SETH DRAKE L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 MANHATTAN CIR STE 104
BOULDER CO
80303-4298
US

IV. Provider business mailing address

4244 REDWOOD PL
BOULDER CO
80301-1639
US

V. Phone/Fax

Practice location:
  • Phone: 303-648-4066
  • Fax:
Mailing address:
  • Phone: 720-402-8192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1818
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: