Provider Demographics
NPI:1669704847
Name:DAISY SLOTTER, INC.
Entity type:Organization
Organization Name:DAISY SLOTTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEAR
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:303-587-3557
Mailing Address - Street 1:PO BOX 735
Mailing Address - Street 2:
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80520-0735
Mailing Address - Country:US
Mailing Address - Phone:303-587-3557
Mailing Address - Fax:303-833-4485
Practice Address - Street 1:161 BERWICK AVENUE
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80520
Practice Address - Country:US
Practice Address - Phone:303-587-3557
Practice Address - Fax:303-833-4485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO726171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty