MEDICARE: DANISHA DRU BOGUE L.AC., M.S.TCM

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.0002321	CO

General Provider Information

NPI Number	:	1649782103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANISHA DRU BOGUE L.AC., M.S.TCM

Provider Business Mailing Address
First Line	:	9763 CHAMBERS CT
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-9284
Country	:	US
Telephone Number	:	970-270-2609
Fax Number	:

Provider Business Practice Location Address
First Line	:	9763 CHAMBERS CT
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-9284
Country	:	US
Telephone Number	:	970-270-2609
Fax Number	:

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

Provider Enumeration Date	:	10/24/2017
Last Update Date	:	10/24/2017

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