Provider Demographics
NPI:1861265993
Name:MACNEIL, ANDREW JAMES (MAC, LAC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:MACNEIL
Suffix:
Gender:M
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4734 FLOWER ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6829
Mailing Address - Country:US
Mailing Address - Phone:172-023-1631
Mailing Address - Fax:
Practice Address - Street 1:3475 BRIARGATE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4188
Practice Address - Country:US
Practice Address - Phone:719-357-9448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002843171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist