MEDICARE: CODY WIERSEMA

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.0001912	CO

General Provider Information

NPI Number	:	1184297657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY WIERSEMA

Provider Business Mailing Address
First Line	:	3855 JULIAN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-1925
Country	:	US
Telephone Number	:	720-201-8831
Fax Number	:

Provider Business Practice Location Address
First Line	:	3855 JULIAN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-1925
Country	:	US
Telephone Number	:	720-201-8831
Fax Number	:

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

Provider Enumeration Date	:	07/21/2021
Last Update Date	:	07/21/2021

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Directions to “ CODY WIERSEMA ” Practice Location

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