Provider Demographics
NPI:1215280169
Name:DRAKE, JOSHUA SETH (LAC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:SETH
Last Name:DRAKE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4244 REDWOOD PL
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1639
Mailing Address - Country:US
Mailing Address - Phone:720-402-8192
Mailing Address - Fax:
Practice Address - Street 1:5353 MANHATTAN CIR STE 104
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4298
Practice Address - Country:US
Practice Address - Phone:303-648-4066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1818171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist