Provider Demographics
NPI:1932447786
Name:CHAVEZ, AMY KRISTINE (LAC, RMT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KRISTINE
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:LAC, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1011
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80001-1011
Mailing Address - Country:US
Mailing Address - Phone:303-882-0973
Mailing Address - Fax:
Practice Address - Street 1:7655 W MISSISSIPPI AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-4332
Practice Address - Country:US
Practice Address - Phone:303-882-0973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0001738171100000X
COMT.0003958225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist