Healthcare Provider Details

I. General information

NPI: 1861958977
Provider Name (Legal Business Name): OPTIMUM VITALITY ACUPUNCTURE AND CHINESE MEDICINE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1699 S COLORADO BLVD UNIT M
DENVER CO
80222-4021
US

IV. Provider business mailing address

1017 S BIRCH ST APT 501B
DENVER CO
80246-2522
US

V. Phone/Fax

Practice location:
  • Phone: 303-953-1471
  • Fax: 303-945-4172
Mailing address:
  • Phone: 720-787-2574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: JUAN M ORRACA
Title or Position: ACUPUNCTURIST
Credential: L.AC
Phone: 720-787-2574