Blackhawk Acupuncture and Herbal Healing Center LLC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

ACU.0001916 Issued in CO

Legal business name

BLACKHAWK ACUPUNCTURE AND HERBAL HEALING CENTER LLC

Doing business as

Pueblo Holistic Wellness Center

Practice address

1307 Fortino Blvd Ste C
Pueblo, CO 81008-2032

Phone

(719) 582-1010

Fax

(719) 631-7012

NPI assigned

Mar 29, 2017

Last updated

Aug 21, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tracey Renee Walker

Title

Managing Member

Phone

(719) 396-5375

Specialties & licenses 1

Addresses

Other names 1

• Pueblo Holistic Wellness Center Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tracey Renee Nicholls, L.AC

  • Acupuncturist
  • Pueblo, CO
  • NPI 1720590615
  NPD
• Sophia Madalena Avila

  • Massage Therapist
  • Pueblo, CO
  • NPI 1285315218
  NPD (past)

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

{
    "created_epoch": "1490745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597968000000",
    "number": "1417489519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 296",
            "city": "BEULAH",
            "state": "CO",
            "postal_code": "810230296",
            "telephone_number": "719-396-5375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1307 FORTINO BLVD STE C",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082032",
            "telephone_number": "719-582-1010",
            "fax_number": "719-631-7012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKHAWK ACUPUNCTURE AND HERBAL HEALING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-29",
        "last_updated": "2020-08-21",
        "certification_date": "2020-08-21",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "719-396-5375"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CO",
            "license": "ACU.0001916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pueblo Holistic Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brandon R Black, M.D.
• Ian H Black, MD
• Jonathan Black
• Kristopher A. Black, CRNA
• Kindal Blackburn
• Shari A Blackmon, M.D.
• Roswitha Blaesius, PT
• Jessica Blaettler, AUD
• Andie Blair
• Alicia Blake

• Acupuncturist in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Acupuncturist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2020; 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.