Provider Demographics
NPI:1376865766
Name:JADE TURTLE WELL-SPA, LLC
Entity type:Organization
Organization Name:JADE TURTLE WELL-SPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST AND HERBALIS
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:ROSELLA
Authorized Official - Last Name:TERINONI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:303-242-7272
Mailing Address - Street 1:5370 MANHATTAN CIR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4250
Mailing Address - Country:US
Mailing Address - Phone:303-242-7272
Mailing Address - Fax:
Practice Address - Street 1:5370 MANHATTAN CIR
Practice Address - Street 2:SUITE 105
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4250
Practice Address - Country:US
Practice Address - Phone:303-242-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1193171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty