Provider Demographics
NPI:1154502219
Name:SHAO, CHRISTINA (LAC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:SHAO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 MANHATTAN CIR
Mailing Address - Street 2:SUITE F
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4240
Mailing Address - Country:US
Mailing Address - Phone:303-499-0152
Mailing Address - Fax:
Practice Address - Street 1:5330 MANHATTAN CIR
Practice Address - Street 2:SUITE F
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4240
Practice Address - Country:US
Practice Address - Phone:303-499-0152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1286171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist