Healthcare Provider Details

I. General information

NPI: 1376304881
Provider Name (Legal Business Name): HEARTSPACE ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9227 E LINCOLN AVE STE 300
LONE TREE CO
80124-5504
US

IV. Provider business mailing address

9227 E LINCOLN AVE STE 300
LONE TREE CO
80124-5504
US

V. Phone/Fax

Practice location:
  • Phone: 303-470-1995
  • Fax:
Mailing address:
  • Phone: 303-470-1995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE JOHNS
Title or Position: OWNER
Credential:
Phone: 303-249-8243