Healthcare Provider Details

I. General information

NPI: 1205251444
Provider Name (Legal Business Name): JENNA MEARS L.AC, DIPL AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12201 PECOS ST STE 100
WESTMINSTER CO
80234-3899
US

IV. Provider business mailing address

13369 RACE ST
THORNTON CO
80241-1952
US

V. Phone/Fax

Practice location:
  • Phone: 303-929-7334
  • Fax: 303-785-8476
Mailing address:
  • Phone: 303-929-7334
  • Fax: 303-785-8476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU-1901
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: