Provider Demographics
NPI:1861958977
Name:OPTIMUM VITALITY ACUPUNCTURE AND CHINESE MEDICINE, LLC.
Entity type:Organization
Organization Name:OPTIMUM VITALITY ACUPUNCTURE AND CHINESE MEDICINE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ORRACA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:720-787-2574
Mailing Address - Street 1:1017 S BIRCH ST APT 501B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2522
Mailing Address - Country:US
Mailing Address - Phone:720-787-2574
Mailing Address - Fax:
Practice Address - Street 1:1699 S COLORADO BLVD UNIT M
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4021
Practice Address - Country:US
Practice Address - Phone:303-953-1471
Practice Address - Fax:303-945-4172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0002229OtherACUPUUNCTURE