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General NPI Number Information
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NPI Number | 1689806697
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Entity Type | Organization
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Legal Business Name | ORIENTAL MEDICINE LLC
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Dates
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Enumeration Date | 08/10/2009
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Last Update Date | 08/10/2009
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Provider Practice Location Address
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Address Line | 2812 W COLORADO AVE SUITE 104
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City | COLORADO SPRINGS
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State | CO
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Zip | 80904-2470
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Country | US
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Telephone | 719-446-0046
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Fax | 719-687-7118
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Provider Business Mailing Address
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Address Line | 2812 W COLORADO AVE SUITE 104
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City | COLORADO SPRINGS
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State | CO
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Zip | 80904-2470
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Country | US
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Telephone | 719-446-0046
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Fax | 719-687-7118
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Authorized Official
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Title or Position | ACUPUNCTURIST/BUSINESS OWNER
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Name | CHARLOTTE R WATTS
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Credential | LAC
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Telephone | 719-447-0046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 1522
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License Number State | CO
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