Healthcare Provider Details

I. General information

NPI: 1154754174
Provider Name (Legal Business Name): CENTER FOR INTEGRATED EASTERN MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 DEPOT HILL RD
BROOMFIELD CO
80020-1068
US

IV. Provider business mailing address

7283 ELLIS ST
ARVADA CO
80005-3578
US

V. Phone/Fax

Practice location:
  • Phone: 303-810-9255
  • Fax: 720-362-5078
Mailing address:
  • Phone: 303-810-9255
  • Fax: 720-362-5078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1551
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1213
License Number StateCO

VIII. Authorized Official

Name: SCOT SOMES
Title or Position: PRESIDENT
Credential: ACUPUNCTURIST
Phone: 303-810-9255