Provider Demographics
NPI:1619292067
Name:PAINTED DOG, INC
Entity Type:Organization
Organization Name:PAINTED DOG, INC
Other - Org Name:SUE WHEELER, L.AC, DIPL.OM
Other - Org Type:Other Name
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:L,AC, DIPLOM
Authorized Official - Phone:720-427-5707
Mailing Address - Street 1:6888 S HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2343
Mailing Address - Country:US
Mailing Address - Phone:720-427-5707
Mailing Address - Fax:303-779-6202
Practice Address - Street 1:5554 S PRINCE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-1149
Practice Address - Country:US
Practice Address - Phone:720-427-5707
Practice Address - Fax:303-779-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1378261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center