Provider Demographics
NPI:1407258353
Name:PREMIER ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:PREMIER ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:AYLSWORTH
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:719-447-0046
Mailing Address - Street 1:2812 W COLORADO AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2481
Mailing Address - Country:US
Mailing Address - Phone:719-447-0046
Mailing Address - Fax:719-447-4546
Practice Address - Street 1:2812 W COLORADO AVE STE 104
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-2481
Practice Address - Country:US
Practice Address - Phone:719-447-0046
Practice Address - Fax:719-447-4546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1709261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service