Provider Demographics
NPI:1790951176
Name:JANTZEN, EUNICE MARIE
Entity Type:Individual
Prefix:MS
First Name:EUNICE
Middle Name:MARIE
Last Name:JANTZEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:EUNICE
Other - Middle Name:
Other - Last Name:JANTZEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, LMT
Mailing Address - Street 1:3210 E WOODMEN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3588
Mailing Address - Country:US
Mailing Address - Phone:719-260-6888
Mailing Address - Fax:
Practice Address - Street 1:3210 E WOODMEN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3588
Practice Address - Country:US
Practice Address - Phone:719-260-6888
Practice Address - Fax:719-593-2371
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1337171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist