Provider Demographics
NPI:1912452244
Name:UNITY COMMUNITY ACUCUPUNCTURE, INC.
Entity Type:Organization
Organization Name:UNITY COMMUNITY ACUCUPUNCTURE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOEDECKE-SHILLING
Authorized Official - Suffix:
Authorized Official - Credentials:DACM
Authorized Official - Phone:720-515-1405
Mailing Address - Street 1:1355 E 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-5220
Mailing Address - Country:US
Mailing Address - Phone:720-515-1405
Mailing Address - Fax:
Practice Address - Street 1:1355 E 22ND AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5220
Practice Address - Country:US
Practice Address - Phone:720-515-1405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1842171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO=========Medicaid