MEDICARE: LUMEN WELLNESS 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	225700000X	Massage Therapist	CAIN438978	CO

General Provider Information

NPI Number	:	1245694975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMEN WELLNESS LLC

Provider Business Mailing Address
First Line	:	3530 KINGSTON CIR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2815
Country	:	US
Telephone Number	:	970-556-3124
Fax Number	:

Provider Business Practice Location Address
First Line	:	3530 KINGSTON CIR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2815
Country	:	US
Telephone Number	:	970-556-3124
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LUKE SCOTT CAIN
Credential	:	LMT
Telephone Number	:	970-556-3124

Provider Enumeration Date	:	04/08/2016
Last Update Date	:	04/08/2016

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