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General NPI Number Information
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NPI Number | 1679627079
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Entity Type | Organization
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Legal Business Name | BLACK FOREST ACUPUNCTURE INC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1465 KELLY JOHNSON BLVD #320
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-3942
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Country | US
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Telephone | 719-598-9200
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Fax | 719-592-0800
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Provider Business Mailing Address
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Address Line | 1465 KELLY JOHNSON BLVD #320
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-3942
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Country | US
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Telephone | 719-598-9200
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Fax | 719-592-0800
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Authorized Official
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Title or Position | OWNER
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Name | CATHERINE M DIMAGGIO
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Credential | LAC
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Telephone | 719-598-9200
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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 | 662
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License Number State | CO
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