Active NPI
Jodie Kim Mactavish
- Acupuncturist
- Grand Junction, CO
National Provider Identifier
1366733545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- ELECTROACUPUNCTURE
- Practice address
- 3096 I-70 Business Loop
Suite D
Grand Junction, CO 81504-5774 - Phone
- (970) 434-8500
- Fax
- (970) 434-8500
- NPI assigned
- Apr 22, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | ELECTROACUPUNCTURE | CO | Primary |
| Reflexologist | 173C00000X | N/A CERTIFICATION | CO |
Addresses
Primary practice location
3096 I-70 Business Loop
Suite D
Grand Junction, CO 81504-5774
Mailing address
3096 I-70 Business Loop
Suite D
Grand Junction, CO 81504
Phone (970) 434-8500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ELECTROACUPUNCTURE | CO | MD | Acupuncturist |
| N/A CERTIFICATION | CO | MD | Reflexologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1303430400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303430400000",
"number": "1366733545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3096 I-70 BUSINESS LOOP",
"address_2": "SUITE D",
"city": "GRAND JUNCTION",
"state": "CO",
"postal_code": "81504",
"telephone_number": "970-434-8500",
"fax_number": "970-434-8500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3096 I-70 BUSINESS LOOP",
"address_2": "SUITE D",
"city": "GRAND JUNCTION",
"state": "CO",
"postal_code": "815045774",
"telephone_number": "970-434-8500",
"fax_number": "970-434-8500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACTAVISH",
"first_name": "JODIE",
"middle_name": "KIM",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-04-22",
"last_updated": "2011-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "CO",
"license": "ELECTROACUPUNCTURE",
"primary": true
},
{
"code": "173C00000X",
"taxonomy_group": "",
"desc": "Reflexologist",
"state": "CO",
"license": "N/A CERTIFICATION",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Junction, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.