Provider Demographics
NPI:1881084689
Name:REHABILITATIVE ACUPUNCTURE LLC.
Entity type:Organization
Organization Name:REHABILITATIVE ACUPUNCTURE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:805-252-6252
Mailing Address - Street 1:2685 S DAYTON WAY APT 252
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-3955
Mailing Address - Country:US
Mailing Address - Phone:805-252-6252
Mailing Address - Fax:
Practice Address - Street 1:3212 TEJON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3431
Practice Address - Country:US
Practice Address - Phone:805-252-6252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-31
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002069171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty