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General NPI Number Information
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NPI Number | 1487987160
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Entity Type | Organization
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Legal Business Name | PHYLLIS HAMAR, LAC
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Dates
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Enumeration Date | 09/11/2009
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Last Update Date | 09/11/2009
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Provider Practice Location Address
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Address Line | 710 11TH AVE STE 106
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City | GREELEY
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State | CO
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Zip | 80631-3200
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Country | US
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Telephone | 970-539-0324
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 121
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City | SEVERANCE
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State | CO
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Zip | 80546-0121
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Country | US
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Telephone | 970-539-0324
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PHYLLIS HAMAR
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Credential | LAC, M.S.T.CM.
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Telephone | 970-539-0324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1431
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License Number State | CO
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