Provider Demographics
NPI:1477515179
Name:BLUNK, SCOTT STEWART (LAC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:STEWART
Last Name:BLUNK
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 1:2601 S LEMAY AVE
Mailing Address - Street 2:SUITE 25
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2295
Mailing Address - Country:US
Mailing Address - Phone:970-223-4422
Mailing Address - Fax:
Practice Address - Street 1:2601 S LEMAY AVE
Practice Address - Street 2:SUITE 25
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2295
Practice Address - Country:US
Practice Address - Phone:970-223-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO568171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist