Healthcare Provider Details

I. General information

NPI: 1255724647
Provider Name (Legal Business Name): BERTRAND BABINET PHD, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 VASQUEZ CT
LYONS CO
80540
US

IV. Provider business mailing address

1750 30THNST #184
BOULDER CO
80301
US

V. Phone/Fax

Practice location:
  • Phone: 303-823-8760
  • Fax: 303-823-5378
Mailing address:
  • Phone: 303-588-0057
  • Fax: 303-823-5378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number563
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: