Provider Demographics
NPI:1679902894
Name:GOLDSTEIN, NOAH (LAC DIPL OM)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:LAC DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 GRANT PL
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-7119
Mailing Address - Country:US
Mailing Address - Phone:617-953-4424
Mailing Address - Fax:
Practice Address - Street 1:1076 GRANT PL
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-7119
Practice Address - Country:US
Practice Address - Phone:617-953-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001925171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist