Provider Demographics
NPI:1386812998
Name:POWELL, JOSEPH RYAN (LAC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:RYAN
Last Name:POWELL
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 1:1129 VIVIAN ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3731
Mailing Address - Country:US
Mailing Address - Phone:720-494-9726
Mailing Address - Fax:
Practice Address - Street 1:1129 VIVIAN ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3731
Practice Address - Country:US
Practice Address - Phone:720-494-9726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-16
Last Update Date:2008-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1374171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist