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General NPI Number Information
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NPI Number | 1407258353
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Entity Type | Organization
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Legal Business Name | PREMIER ACUPUNCTURE CLINIC
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 04/13/2015
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Provider Practice Location Address
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Address Line | 2812 W COLORADO AVE STE 104
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City | COLORADO SPRINGS
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State | CO
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Zip | 80904-2481
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Country | US
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Telephone | 719-447-0046
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Fax | 719-447-4546
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Provider Business Mailing Address
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Address Line | 2812 W COLORADO AVE STE 104
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City | COLORADO SPRINGS
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State | CO
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Zip | 80904-2481
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Country | US
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Telephone | 719-447-0046
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Fax | 719-447-4546
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Authorized Official
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Title or Position | OWNER
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Name | ANNE AYLSWORTH SCHULTZ
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Credential | LAC
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Telephone | 719-447-0046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 1709
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License Number State | CO
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