Provider Demographics
NPI:1508295031
Name:HERBST, EMILY (LAC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:HERBST
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6145 CODY ST
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-5432
Mailing Address - Country:US
Mailing Address - Phone:307-752-4557
Mailing Address - Fax:
Practice Address - Street 1:660 GOLDEN RIDGE RD
Practice Address - Street 2:SUITE #250
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-9541
Practice Address - Country:US
Practice Address - Phone:303-233-1223
Practice Address - Fax:303-233-8755
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1857171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist