MEDICARE: CASEY CALKINS M.S.O.M., L.AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	ACU.0002567	CO

General Provider Information

NPI Number	:	1023643228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY CALKINS M.S.O.M., L.AC.

Provider Business Mailing Address
First Line	:	PO BOX 745043
Second Line	:
City	:	ARVADA
State	:	CO
Zip	:	80006-5043
Country	:	US
Telephone Number	:	970-691-5914
Fax Number	:

Provider Business Practice Location Address
First Line	:	948 NORTH ST STE 6
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-3385
Country	:	US
Telephone Number	:	303-545-5792
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2020
Last Update Date	:	03/08/2020

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