Healthcare Provider Details

I. General information

NPI: 1992611198
Provider Name (Legal Business Name): BENJAMIN ROBERT KNAPP L. AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 BROADWAY ST STE 205
BOULDER CO
80305-3338
US

IV. Provider business mailing address

350 BROADWAY ST STE 205
BOULDER CO
80305-3338
US

V. Phone/Fax

Practice location:
  • Phone: 720-491-1415
  • Fax:
Mailing address:
  • Phone: 720-491-1415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU.0002554
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: