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General NPI Number Information
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NPI Number | 1861958977
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Entity Type | Organization
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Legal Business Name | OPTIMUM VITALITY ACUPUNCTURE AND CHINESE MEDICINE, LLC.
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 02/13/2019
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Provider Practice Location Address
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Address Line | 1699 S COLORADO BLVD UNIT M
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City | DENVER
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State | CO
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Zip | 80222-4021
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Country | US
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Telephone | 303-953-1471
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Fax | 303-945-4172
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Provider Business Mailing Address
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Address Line | 1017 S BIRCH ST APT 501B
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City | DENVER
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State | CO
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Zip | 80246-2522
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Country | US
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Telephone | 720-787-2574
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | JUAN M ORRACA
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Credential | L.AC
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Telephone | 720-787-2574
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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 |
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License Number State |
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