Provider Demographics
NPI:1740443696
Name:DIMSON, STUART DANIEL (LAC DOM)
Entity type:Individual
Prefix:MR
First Name:STUART
Middle Name:DANIEL
Last Name:DIMSON
Suffix:
Gender:M
Credentials:LAC DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 US HIGHWAY 287
Mailing Address - Street 2:# 100
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-7080
Mailing Address - Country:US
Mailing Address - Phone:303-469-0353
Mailing Address - Fax:303-469-1066
Practice Address - Street 1:1140 US HIGHWAY 287
Practice Address - Street 2:# 100
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7080
Practice Address - Country:US
Practice Address - Phone:303-469-0353
Practice Address - Fax:303-469-1066
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1333171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist