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NPI Code Detail

MEDICARE: SAVANNAH RUSSELL L.AC.

MEDICARE: SAVANNAH RUSSELL 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
1171100000XAcupuncturistACU.0002183CO

General Provider Information

NPI Number : 1134580806
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAVANNAH RUSSELL L.AC.
Provider Business Mailing Address
First Line : 815 MAPLE ST
Second Line :
City : FORT COLLINS
State : CO
Zip : 80521-1904
Country : US
Telephone Number : 707-485-2147
Fax Number :
Provider Business Practice Location Address
First Line : 313 W DRAKE RD
Second Line : SUITE 210
City : FORT COLLINS
State : CO
Zip : 80526-2846
Country : US
Telephone Number : 970-472-0955
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2016
Last Update Date : 03/09/2016

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Directions to “ SAVANNAH RUSSELL L.AC.” Practice Location

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