Provider Demographics
NPI:1861773699
Name:WELLSPRING ACUPUNCTURE AND ORIENTAL MEDICINE, PLLC
Entity type:Organization
Organization Name:WELLSPRING ACUPUNCTURE AND ORIENTAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KONIKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-382-0321
Mailing Address - Street 1:2530 COLORADO AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4760
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2530 COLORADO AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4760
Practice Address - Country:US
Practice Address - Phone:970-382-0321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1690171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty