Provider Demographics
NPI:1114413531
Name:GINKGO ACUPUNCTURE, LLC
Entity type:Organization
Organization Name:GINKGO ACUPUNCTURE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:VAN MAARTH
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:720-636-8258
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:THERMOPOLIS
Mailing Address - State:WY
Mailing Address - Zip Code:82443-0949
Mailing Address - Country:US
Mailing Address - Phone:720-636-8258
Mailing Address - Fax:720-636-8256
Practice Address - Street 1:316 BROADWAY ST STE 3
Practice Address - Street 2:
Practice Address - City:THERMOPOLIS
Practice Address - State:WY
Practice Address - Zip Code:82443-2740
Practice Address - Country:US
Practice Address - Phone:720-636-8258
Practice Address - Fax:720-636-8256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-09
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1519171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1316179872OtherNPPES