Provider Demographics
NPI:1871818757
Name:YAMPA VALLEY ACUPUNCTURE & CHINESE HERBS, LLC
Entity Type:Organization
Organization Name:YAMPA VALLEY ACUPUNCTURE & CHINESE HERBS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:MCDANELD
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:970-819-6738
Mailing Address - Street 1:40460 HARBOR PL
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8422
Mailing Address - Country:US
Mailing Address - Phone:970-819-6738
Mailing Address - Fax:970-871-9190
Practice Address - Street 1:57 10TH STREET
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487
Practice Address - Country:US
Practice Address - Phone:970-819-6738
Practice Address - Fax:970-871-9190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1139171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty