Provider Demographics
NPI:1134471451
Name:AYERS, BRUCE (LAC,CRT)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:AYERS
Suffix:
Gender:M
Credentials:LAC,CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28000 MEADOW DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-8395
Mailing Address - Country:US
Mailing Address - Phone:720-320-7794
Mailing Address - Fax:
Practice Address - Street 1:28000 MEADOW DR
Practice Address - Street 2:SUITE 10
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-8395
Practice Address - Country:US
Practice Address - Phone:720-320-7794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1102171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist