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General NPI Number Information
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NPI Number | 1467814442
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Entity Type | Organization
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Legal Business Name | THE MEDICINE TREE
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Dates
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Enumeration Date | 03/28/2016
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Last Update Date | 03/28/2016
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Provider Practice Location Address
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Address Line | 1735 E 17TH AVE SUITE 1
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City | DENVER
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State | CO
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Zip | 80218-1683
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Country | US
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Telephone | 770-722-9421
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Fax |
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Provider Business Mailing Address
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Address Line | 4995 VALLEJO ST
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City | DENVER
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State | CO
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Zip | 80221-1361
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Country | US
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Telephone | 770-722-9421
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | ELIZABETH ROPER
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Credential | L.AC
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Telephone | 770-722-9421
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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 | 0002192
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License Number State | CO
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