Healthcare Provider Details

I. General information

NPI: 1710298963
Provider Name (Legal Business Name): CHRISTOPHER BROWN MSOM, LAC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 CENTRAL AVE SUITE 55
BOULDER CO
80301-2871
US

IV. Provider business mailing address

5757 CENTRAL AVE SUITE 55
BOULDER CO
80301-2871
US

V. Phone/Fax

Practice location:
  • Phone: 303-817-3938
  • Fax:
Mailing address:
  • Phone: 303-817-3938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU-1348
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: