Provider Demographics
NPI:1548522766
Name:FIVE ROADS INC
Entity type:Organization
Organization Name:FIVE ROADS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DURGIN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DIPL OF OM
Authorized Official - Phone:303-921-2993
Mailing Address - Street 1:775 E 11TH AVE
Mailing Address - Street 2:UNIT 7
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2665
Mailing Address - Country:US
Mailing Address - Phone:303-921-2993
Mailing Address - Fax:
Practice Address - Street 1:612 WASHINGTON ST
Practice Address - Street 2:SUITE 112
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3800
Practice Address - Country:US
Practice Address - Phone:303-921-2993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1726171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty