Healthcare Provider Details

I. General information

NPI: 1750692265
Provider Name (Legal Business Name): BETRU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 E 29TH AVE SUITE 204
DENVER CO
80238-2720
US

IV. Provider business mailing address

7350 E 29TH AVE SUITE 204
DENVER CO
80238-2720
US

V. Phone/Fax

Practice location:
  • Phone: 303-573-7484
  • Fax: 303-573-0994
Mailing address:
  • Phone: 303-573-7484
  • Fax: 303-573-0994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1170
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number4897
License Number StateCO

VIII. Authorized Official

Name: MEGAN M LONG
Title or Position: OWNER
Credential: L.AC.
Phone: 303-573-7484