Healthcare Provider Details

I. General information

NPI: 1952946121
Provider Name (Legal Business Name): ANDREW PARKS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 S BEECH ST
CORTEZ CO
81321-3744
US

IV. Provider business mailing address

18 S BEECH ST
CORTEZ CO
81321-3744
US

V. Phone/Fax

Practice location:
  • Phone: 970-565-0230
  • Fax:
Mailing address:
  • Phone: 970-565-0230
  • Fax: 970-565-3463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU.0002517
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: