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General NPI Number Information
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NPI Number | 1447756150
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Entity Type | Organization
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Legal Business Name | WILD BLUE HEALTHCARE LLC
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 04/07/2021
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Provider Practice Location Address
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Address Line | 401 E CLEVELAND ST STE C
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City | LAFAYETTE
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State | CO
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Zip | 80026-2399
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Country | US
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Telephone | 720-299-3829
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Fax |
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Provider Business Mailing Address
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Address Line | 810 HARRISON DR
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City | LAFAYETTE
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State | CO
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Zip | 80026-1815
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Country | US
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Telephone | 303-641-7123
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERIN ELIZABETH MEYERS
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Credential | L.AC.
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Telephone | 720-299-3829
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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 | ACU.0002367
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License Number State | CO
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