Provider Demographics
NPI:1760177281
Name:CODY, ESME (LAC)
Entity type:Individual
Prefix:
First Name:ESME
Middle Name:
Last Name:CODY
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:ESME
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:4440 ARAPAHOE AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303
Mailing Address - Country:US
Mailing Address - Phone:720-505-5323
Mailing Address - Fax:720-505-5328
Practice Address - Street 1:4440 ARAPAHOE AVE STE 215
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303
Practice Address - Country:US
Practice Address - Phone:720-505-5323
Practice Address - Fax:720-505-5328
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002797171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist