Healthcare Provider Details

I. General information

NPI: 1477708170
Provider Name (Legal Business Name): EVE MARIE KOCUREK L.AC.,L.CH.,D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4303 ULYSSES WAY
GOLDEN CO
80403-1918
US

IV. Provider business mailing address

4303 ULYSSES WAY
GOLDEN CO
80403-1918
US

V. Phone/Fax

Practice location:
  • Phone: 720-394-4105
  • Fax:
Mailing address:
  • Phone: 720-394-4105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number736
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: