Healthcare Provider Details

I. General information

NPI: 1265633606
Provider Name (Legal Business Name): CHRISTIN DAWN HAWBAKER L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 E MAIN ST
CEDAREDGE CO
81413-3331
US

IV. Provider business mailing address

175 E MAIN ST
CEDAREDGE CO
81413-3331
US

V. Phone/Fax

Practice location:
  • Phone: 970-856-4729
  • Fax: 970-856-9999
Mailing address:
  • Phone: 970-856-4729
  • Fax: 970-856-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number927
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier927
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerSTATE OF COLORADO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: