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General NPI Number Information
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NPI Number | 1154513331
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Entity Type | Individual
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Provider Name | KENT WILKINSON NIXON D.O.M., L.AC.
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Gender | Male
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 723 CHERRY ST
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City | FORT COLLINS
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State | CO
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Zip | 80521-1912
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Country | US
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Telephone | 970-482-3700
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Fax | 970-482-3700
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Provider Business Mailing Address
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Address Line | 723 CHERRY ST
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City | FORT COLLINS
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State | CO
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Zip | 80521-1912
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Country | US
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Telephone | 970-482-3700
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Fax | 970-482-3700
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1192
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License Number State | CO
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