Provider Demographics
NPI:1578937553
Name:VICK, BRIAN (LAC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:VICK
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 1:90 MADISON ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5418
Mailing Address - Country:US
Mailing Address - Phone:303-668-1229
Mailing Address - Fax:
Practice Address - Street 1:90 MADISON ST
Practice Address - Street 2:SUITE 402
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5418
Practice Address - Country:US
Practice Address - Phone:303-668-1229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1357171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist