Provider Demographics
NPI:1336498088
Name:DAVIDOV, KALIN TODOROV (LAC, DOM)
Entity Type:Individual
Prefix:
First Name:KALIN
Middle Name:TODOROV
Last Name:DAVIDOV
Suffix:
Gender:M
Credentials:LAC, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 S MONACO PKWY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1811
Mailing Address - Country:US
Mailing Address - Phone:720-277-7312
Mailing Address - Fax:
Practice Address - Street 1:3955 E EXPOSITION AVE STE 320
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-5033
Practice Address - Country:US
Practice Address - Phone:303-777-1151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-09
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002108171100000X
COMT13033174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No174400000XOther Service ProvidersSpecialist