Misty Mountain Medicine

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

1613 Issued in CO

Legal business name

MISTY MOUNTAIN MEDICINE

Practice address

3555 Merriment Way
Colorado Springs, CO 80917-2557

Phone

(505) 366-4033

NPI assigned

Feb 21, 2008

Organization subpart

No

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

Authorized official

Name

Lacretia Yvonne Bajwa, DOM

Title

Owner

Phone

(505) 366-4033

Specialties & licenses 2

Addresses

Other names 1

• Firehealer Other name

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

{
    "created_epoch": "1203552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287964800000",
    "number": "1982873287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26111",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809366111",
            "telephone_number": "505-366-4033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3555 MERRIMENT WAY",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809172557",
            "telephone_number": "505-366-4033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISTY MOUNTAIN MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-21",
        "last_updated": "2010-10-25",
        "status": "A",
        "authorized_official_last_name": "BAJWA",
        "authorized_official_first_name": "LACRETIA",
        "authorized_official_middle_name": "YVONNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-366-4033",
        "authorized_official_credential": "DOM"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": "NM",
            "license": null,
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": "CO",
            "license": "1613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Firehealer",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Mission Possible
• Mission Possible
• Mission Possible
• Missions Behavioral Health
• Shawna M Mistretta, R.N.
• Kristopher Jeffery Mitcell
• Jason Paul Mitcham, C.PED
• Mitchell J Mayo (Mayo Ocular Prosthetics)
• Saskeia Mitchell-Calixte, BA
• Andrea Mitchell, RBT

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2010; 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.