Provider Demographics
NPI:1376562041
Name:BARTLETT, KIM ELLEN (DIPL OF ACUPUNCTURE)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ELLEN
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:DIPL OF ACUPUNCTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28351 MEADOW RUE RD
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-8305
Mailing Address - Country:US
Mailing Address - Phone:303-679-1284
Mailing Address - Fax:
Practice Address - Street 1:28351 MEADOW RUE RD
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-8305
Practice Address - Country:US
Practice Address - Phone:303-679-1284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO523171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist