Provider Demographics
NPI:1477515179
Name:BLUNK, SCOTT STEWART (LAC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:STEWART
Last Name:BLUNK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:BELLVUE
Mailing Address - State:CO
Mailing Address - Zip Code:80512-0188
Mailing Address - Country:US
Mailing Address - Phone:970-449-3768
Mailing Address - Fax:720-726-2387
Practice Address - Street 1:2601 S LEMAY AVE
Practice Address - Street 2:SUITE 25
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2295
Practice Address - Country:US
Practice Address - Phone:970-449-3768
Practice Address - Fax:720-726-2387
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO568171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist