Provider Demographics
NPI:1689806697
Name:ORIENTAL MEDICINE LLC
Entity Type:Organization
Organization Name:ORIENTAL MEDICINE LLC
Other - Org Name:PREMIER ACUPUNCTURE CLINIC OF COLORADO SPRINGS
Other - Org Type:Other Name
Authorized Official - Title/Position:ACUPUNCTURIST/BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:R
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:719-447-0046
Mailing Address - Street 1:2812 W COLORADO AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2470
Mailing Address - Country:US
Mailing Address - Phone:719-446-0046
Mailing Address - Fax:719-687-7118
Practice Address - Street 1:2812 W COLORADO AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-2470
Practice Address - Country:US
Practice Address - Phone:719-446-0046
Practice Address - Fax:719-687-7118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1522261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service