Healthcare Provider Details

I. General information

NPI: 1982927620
Provider Name (Legal Business Name): LEONARD SOCOLOV L. AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 ADONIS CT
LAFAYETTE CO
80026-1406
US

IV. Provider business mailing address

1407 ADONIS CT
LAFAYETTE CO
80026-1406
US

V. Phone/Fax

Practice location:
  • Phone: 303-517-4722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number152
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: