Provider Demographics
NPI:1700195054
Name:ESSENCE OF HEALING, PC
Entity Type:Organization
Organization Name:ESSENCE OF HEALING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-533-1024
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:MANCOS
Mailing Address - State:CO
Mailing Address - Zip Code:81328-0688
Mailing Address - Country:US
Mailing Address - Phone:970-533-1024
Mailing Address - Fax:970-533-1025
Practice Address - Street 1:164 EAST FRONTAGE STREET
Practice Address - Street 2:
Practice Address - City:MANCOS
Practice Address - State:CO
Practice Address - Zip Code:81328
Practice Address - Country:US
Practice Address - Phone:970-533-1024
Practice Address - Fax:970-533-1025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty