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General NPI Number Information
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NPI Number | 1871818757
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Entity Type | Organization
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Legal Business Name | YAMPA VALLEY ACUPUNCTURE & CHINESE HERBS, LLC
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Dates
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Enumeration Date | 04/02/2010
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Last Update Date | 04/02/2010
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Provider Practice Location Address
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Address Line | 57 10TH STREET
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City | STEAMBOAT SPRINGS
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State | CO
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Zip | 80487
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Country | US
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Telephone | 970-819-6738
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Fax | 970-871-9190
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Provider Business Mailing Address
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Address Line | 40460 HARBOR PL
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City | STEAMBOAT SPRINGS
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State | CO
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Zip | 80487-8422
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Country | US
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Telephone | 970-819-6738
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Fax | 970-871-9190
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Authorized Official
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Title or Position | MEMBER, ACUPUNCTURIST
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Name | KELLEY BROOKE MCDANELD
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Credential | L.AC.
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Telephone | 970-819-6738
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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 | 1139
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License Number State | CO
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