Provider Demographics
NPI:1538443536
Name:BECKER COLBY, JULIE RENATE (LAC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:RENATE
Last Name:BECKER COLBY
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 1:1139 5TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1301
Mailing Address - Country:US
Mailing Address - Phone:612-240-3883
Mailing Address - Fax:
Practice Address - Street 1:2854 JOHNSON ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-3056
Practice Address - Country:US
Practice Address - Phone:612-788-0895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN18677171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist