Provider Demographics
NPI:1124578448
Name:BLOOMING ACUPUNCTURE
Entity type:Organization
Organization Name:BLOOMING ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:LORA
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRES
Authorized Official - Suffix:
Authorized Official - Credentials:LAC DIPLAC
Authorized Official - Phone:303-956-0490
Mailing Address - Street 1:4777 MCKINLEY DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1142
Mailing Address - Country:US
Mailing Address - Phone:303-956-0490
Mailing Address - Fax:
Practice Address - Street 1:1800 30TH ST # 220H
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1088
Practice Address - Country:US
Practice Address - Phone:303-449-9088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1733336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy