Provider Demographics
NPI:1891175535
Name:ACUPUNCTURE OSTEOPATHIC MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:ACUPUNCTURE OSTEOPATHIC MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLICE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:720-840-9187
Mailing Address - Street 1:12001 W 63RD PL
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-4034
Mailing Address - Country:US
Mailing Address - Phone:720-840-9187
Mailing Address - Fax:303-425-6399
Practice Address - Street 1:12001 W 63RD PL
Practice Address - Street 2:SUITE ONE
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-4034
Practice Address - Country:US
Practice Address - Phone:720-840-9187
Practice Address - Fax:303-425-6399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20151371118171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty