MEDICARE: NIKOLE MARIN MAXEY 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
1	171100000X	Acupuncturist	1566	CO

General Provider Information

NPI Number	:	1760707004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKOLE MARIN MAXEY L.AC.

Provider Business Mailing Address
First Line	:	2530 W 29TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3712
Country	:	US
Telephone Number	:	720-855-3160
Fax Number	:	720-855-3660

Provider Business Practice Location Address
First Line	:	2530 W 29TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3712
Country	:	US
Telephone Number	:	720-855-3160
Fax Number	:	720-855-3660

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

Provider Enumeration Date	:	03/30/2010
Last Update Date	:	03/30/2010

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