Provider Demographics
NPI:1679627079
Name:BLACK FOREST ACUPUNCTURE INC
Entity Type:Organization
Organization Name:BLACK FOREST ACUPUNCTURE INC
Other - Org Name:NORTH SPRINGS ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIMAGGIO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:719-598-9200
Mailing Address - Street 1:1465 KELLY JOHNSON BLVD
Mailing Address - Street 2:#320
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3942
Mailing Address - Country:US
Mailing Address - Phone:719-598-9200
Mailing Address - Fax:719-592-0800
Practice Address - Street 1:1465 KELLY JOHNSON BLVD
Practice Address - Street 2:#320
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3942
Practice Address - Country:US
Practice Address - Phone:719-598-9200
Practice Address - Fax:719-592-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO662171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty