Boulder Acusport LLC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

ACU.0002068 Issued in CO

Legal business name

BOULDER ACUSPORT LLC

Practice address

3400 Table Mesa Dr Ste 201
Boulder, CO 80305-5850

Phone

(720) 441-4325

NPI assigned

Feb 19, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mary V Ellis

Title

Owner

Phone

(720) 441-4325

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1424304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424304000000",
    "number": "1265824866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 TABLE MESA DR STE 201",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803055850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 TABLE MESA DR STE 201",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803055850",
            "telephone_number": "720-441-4325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER ACUSPORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-19",
        "last_updated": "2015-02-19",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "720-441-4325"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Acupuncturist",
            "state": "CO",
            "license": "ACU.0002068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.