=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992359855
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DORIE ELIZABETH BACHMANN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2019
-----------------------------------------------------
Last Update Date | 07/30/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6662 GUNPARK DR STE 200
-----------------------------------------------------
City | BOULDER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80301-3379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-665-2242
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 835 SNOWBERRY ST
-----------------------------------------------------
City | LONGMONT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80503-7364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-332-9856
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT.0014576
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------