Healthcare Provider Details

I. General information

NPI: 1477515179
Provider Name (Legal Business Name): SCOTT STEWART BLUNK LAC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 S LEMAY AVE SUITE 25
FORT COLLINS CO
80525-2295
US

IV. Provider business mailing address

PO BOX 188
BELLVUE CO
80512-0188
US

V. Phone/Fax

Practice location:
  • Phone: 970-449-3768
  • Fax: 720-726-2387
Mailing address:
  • Phone: 970-449-3768
  • Fax: 720-726-2387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number568
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: