Provider Demographics
NPI:1861763500
Name:LUM, KRISTEN
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:LUM
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:LUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND, LAC
Mailing Address - Street 1:3750 MAIN AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4033
Mailing Address - Country:US
Mailing Address - Phone:970-382-9100
Mailing Address - Fax:
Practice Address - Street 1:3750 MAIN AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4033
Practice Address - Country:US
Practice Address - Phone:970-382-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1256171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist