Provider Demographics
NPI:1225135734
Name:BRECKENRIDGE ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:BRECKENRIDGE ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER LICENSED ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:NATALIE
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:MSOM LAC
Authorized Official - Phone:970-470-3347
Mailing Address - Street 1:PO BOX 9661
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424
Mailing Address - Country:US
Mailing Address - Phone:970-470-3347
Mailing Address - Fax:
Practice Address - Street 1:237 S. RIDGE ST.
Practice Address - Street 2:SUITE 2
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424
Practice Address - Country:US
Practice Address - Phone:970-470-3347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO868171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty