Provider Demographics
NPI:1477753309
Name:HAUGEN, RICHARD D (NMT, LMT, CMT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:D
Last Name:HAUGEN
Suffix:
Gender:M
Credentials:NMT, LMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 COUNTY ROAD 51
Mailing Address - Street 2:
Mailing Address - City:DIVIDE
Mailing Address - State:CO
Mailing Address - Zip Code:80814-9149
Mailing Address - Country:US
Mailing Address - Phone:719-687-5070
Mailing Address - Fax:
Practice Address - Street 1:391 COUNTY ROAD 51
Practice Address - Street 2:
Practice Address - City:DIVIDE
Practice Address - State:CO
Practice Address - Zip Code:80814-9149
Practice Address - Country:US
Practice Address - Phone:719-687-5070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO710589 - 16316225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist