Provider Demographics
NPI:1114974565
Name:WAN, WILLIAM (DIPLOM, MS, LAC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:WAN
Suffix:
Gender:M
Credentials:DIPLOM, MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 S CASCADE AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3803
Mailing Address - Country:US
Mailing Address - Phone:971-221-6414
Mailing Address - Fax:866-576-3412
Practice Address - Street 1:333 S CASCADE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3803
Practice Address - Country:US
Practice Address - Phone:971-221-6414
Practice Address - Fax:866-576-3412
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-ACU-LIC-41018171100000X
COACU.0002635171100000X
ORAC00919171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist