Provider Demographics
NPI:1134486012
Name:ASTOR, ELIZABETH F (LAC, MSOM)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:F
Last Name:ASTOR
Suffix:
Gender:F
Credentials:LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 DEWEY AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-4003
Mailing Address - Country:US
Mailing Address - Phone:720-684-9018
Mailing Address - Fax:
Practice Address - Street 1:815 DEWEY AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3957
Practice Address - Country:US
Practice Address - Phone:720-722-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1735171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist