Provider Demographics
NPI:1649886227
Name:GUTMAN, ISAAC DAVID (LAC)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:DAVID
Last Name:GUTMAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 W GILL PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-2302
Mailing Address - Country:US
Mailing Address - Phone:303-817-5625
Mailing Address - Fax:
Practice Address - Street 1:1441 YORK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-2157
Practice Address - Country:US
Practice Address - Phone:303-817-5625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-19
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001965171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist