Provider Demographics
NPI:1164933099
Name:BACKUPUNCTURE LLC
Entity Type:Organization
Organization Name:BACKUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAWES
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:720-370-2711
Mailing Address - Street 1:PO BOX 202876
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-8876
Mailing Address - Country:US
Mailing Address - Phone:720-370-2711
Mailing Address - Fax:
Practice Address - Street 1:950 JERSEY ST APT C
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4597
Practice Address - Country:US
Practice Address - Phone:720-370-2711
Practice Address - Fax:720-370-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO897171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty