Healthcare Provider Details

I. General information

NPI: 1396098240
Provider Name (Legal Business Name): TWELVE BRANCHES HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

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

5353 MANHATTAN CIR STE 104
BOULDER CO
80303-4298
US

V. Phone/Fax

Practice location:
  • Phone: 303-648-4066
  • Fax:
Mailing address:
  • Phone: 303-648-4066
  • 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: MR. JOSHUA SETH DRAKE
Title or Position: OWNER
Credential: L.AC
Phone: 720-402-8192