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General NPI Number Information
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NPI Number | 1881810612
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Entity Type | Individual
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Provider Name | TROY E. SAMMONS M.AC.O.M., L.AC.
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Gender | Male
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 02/16/2010
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Provider Practice Location Address
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Address Line | 115 W 11TH ST
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City | PUEBLO
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State | CO
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Zip | 81003-2801
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Country | US
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Telephone | 719-544-3326
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Fax |
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Provider Business Mailing Address
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Address Line | 888 S AVENIDA DEL ORO W
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City | PUEBLO WEST
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State | CO
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Zip | 81007-6191
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Country | US
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Telephone | 719-250-4090
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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 | 567
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License Number State | CO
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