Healthcare Provider Details

I. General information

NPI: 1205037082
Provider Name (Legal Business Name): JILL ADRIAN TUCCI LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 BEACON ST SUITE A
COLO SPGS CO
80907-5553
US

IV. Provider business mailing address

3113 N PROSPECT ST
COLO SPRINGS CO
80907-5553
US

V. Phone/Fax

Practice location:
  • Phone: 719-634-3010
  • Fax:
Mailing address:
  • Phone: 719-634-8706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number143
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: