Provider Demographics
NPI:1699207191
Name:KAILO ACUPUNCTURE AND MASSAGE, INCORPORATED
Entity Type:Organization
Organization Name:KAILO ACUPUNCTURE AND MASSAGE, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:THALIA
Authorized Official - Last Name:LEFCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-612-7429
Mailing Address - Street 1:2095 W 6TH AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1870
Mailing Address - Country:US
Mailing Address - Phone:720-612-7429
Mailing Address - Fax:
Practice Address - Street 1:2095 W 6TH AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1870
Practice Address - Country:US
Practice Address - Phone:720-612-7429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0000887171100000X
COMT.0004934225700000X
COMT.0001214225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty