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General NPI Number Information
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NPI Number | 1609081116
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Entity Type | Individual
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Provider Name | MARY BERG MALKIEL RN. LAC
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Gender | Female
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 02/20/2014
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Provider Practice Location Address
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Address Line | 972 W DILLON RD SUITE 1
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City | LOUISVILLE
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State | CO
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Zip | 80027-9448
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Country | US
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Telephone | 303-955-7226
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20703
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City | BOULDER
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State | CO
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Zip | 80308-3703
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Country | US
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Telephone | 303-807-1624
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Fax |
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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 | CO883
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License Number State | CO
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