Provider Demographics
NPI:1598717233
Name:CHRISTIAN, MARY KAY (LIC ACUP & C HERBOLO)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:KAY
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:LIC ACUP & C HERBOLO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205
Mailing Address - Country:US
Mailing Address - Phone:303-831-7072
Mailing Address - Fax:303-831-9114
Practice Address - Street 1:2340 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205
Practice Address - Country:US
Practice Address - Phone:303-831-7072
Practice Address - Fax:303-831-7072
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO387171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
710870704OtherTAX ID NUMBER