Healthcare Provider Details

I. General information

NPI: 1912363474
Provider Name (Legal Business Name): CENTER FOR INTEGRATED EASTERN MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/13/2016
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

14081 W 72ND AVE
ARVADA CO
80005-4615
US

V. Phone/Fax

Practice location:
  • Phone: 303-810-9255
  • Fax: 719-309-0814
Mailing address:
  • Phone: 303-810-9255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1213
License Number StateCO

VIII. Authorized Official

Name: SCOT SOMES
Title or Position: PRESIDENT/OWNER
Credential: LAC.
Phone: 303-810-9255