Provider Demographics
NPI:1366816209
Name:HEART SOURCE ACUPUNCTURE, ENERGY AND WELLNESS
Entity Type:Organization
Organization Name:HEART SOURCE ACUPUNCTURE, ENERGY AND WELLNESS
Other - Org Name:HEART SOURCE WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:303-929-3221
Mailing Address - Street 1:6775 S IVY ST APT A2
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1099
Mailing Address - Country:US
Mailing Address - Phone:303-929-3221
Mailing Address - Fax:
Practice Address - Street 1:6595 S DAYTON ST
Practice Address - Street 2:SUITE 1600
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-6128
Practice Address - Country:US
Practice Address - Phone:303-929-3221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1697171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty