Provider Demographics
NPI:1407819105
Name:REAVES, WHITFIELD (LAC)
Entity Type:Individual
Prefix:
First Name:WHITFIELD
Middle Name:
Last Name:REAVES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2067
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80306-2067
Mailing Address - Country:US
Mailing Address - Phone:303-552-8722
Mailing Address - Fax:
Practice Address - Street 1:2760 29TH ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1214
Practice Address - Country:US
Practice Address - Phone:303-552-8722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2011-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO146171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist