Provider Demographics
NPI:1952440869
Name:WING, RANDEL B (DOM, LAC, NMD)
Entity Type:Individual
Prefix:
First Name:RANDEL
Middle Name:B
Last Name:WING
Suffix:
Gender:M
Credentials:DOM, LAC, NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 W COLORADO AVE STE 106
Mailing Address - Street 2:ACUPUNCTURE CLINIC
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2481
Mailing Address - Country:US
Mailing Address - Phone:719-447-0046
Mailing Address - Fax:719-687-7118
Practice Address - Street 1:2812 W COLORADO AVE STE 106
Practice Address - Street 2:ACUPUNCTURE CLINIC
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-2481
Practice Address - Country:US
Practice Address - Phone:719-447-0046
Practice Address - Fax:719-687-7118
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO392171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist