Provider Demographics
NPI:1801118633
Name:WOLLEN, JOSEPH C (LAC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:WOLLEN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:C
Other - Last Name:WOLLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:606 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-3202
Mailing Address - Country:US
Mailing Address - Phone:720-234-0967
Mailing Address - Fax:
Practice Address - Street 1:606 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-3202
Practice Address - Country:US
Practice Address - Phone:720-234-0967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-21
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1517171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist