MEDICARE: FIVE PETALS HEALTH LLC

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	1380	CO

General Provider Information

NPI Number	:	1114241148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIVE PETALS HEALTH LLC

Provider Business Mailing Address
First Line	:	948 NORTH ST STE 3
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-3385
Country	:	US
Telephone Number	:	720-280-9970
Fax Number	:

Provider Business Practice Location Address
First Line	:	948 NORTH ST STE 3
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-3385
Country	:	US
Telephone Number	:	720-280-9970
Fax Number	:

Authorized Official
Title or Position	:	OWER/OPERATOR
Name	:	JENNIFER CARROLL
Credential	:	L.AC
Telephone Number	:	720-280-9970

Provider Enumeration Date	:	03/19/2010
Last Update Date	:	03/31/2022

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Directions to “FIVE PETALS HEALTH LLC ” Practice Location

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