Provider Demographics
NPI:1679091235
Name:INTEGRATIVE ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:INTEGRATIVE ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:L-AC
Authorized Official - Phone:970-493-0025
Mailing Address - Street 1:140 W OAK ST STE 110
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2895
Mailing Address - Country:US
Mailing Address - Phone:970-493-0025
Mailing Address - Fax:970-484-2088
Practice Address - Street 1:140 W OAK ST STE 110
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2895
Practice Address - Country:US
Practice Address - Phone:970-493-0025
Practice Address - Fax:970-484-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002174171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty