MEDICARE: EAST WINDS ACUPUNCTURE

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

General Provider Information

NPI Number	:	1952935009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST WINDS ACUPUNCTURE

Provider Business Mailing Address
First Line	:	1422 N HANCOCK AVE STE 5
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-2641
Country	:	US
Telephone Number	:	719-520-5056
Fax Number	:	719-520-5222

Provider Business Practice Location Address
First Line	:	1422 N HANCOCK AVE STE 5
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-2641
Country	:	US
Telephone Number	:	719-520-5056
Fax Number	:	719-520-5222

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DIANE K CRIDENNDA
Credential	:	LAC
Telephone Number	:	719-520-5056

Provider Enumeration Date	:	02/27/2020
Last Update Date	:	02/27/2020

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Directions to “EAST WINDS ACUPUNCTURE ” Practice Location

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