Provider Demographics
NPI:1023643228
Name:CALKINS, CASEY (MSOM, LAC)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:CALKINS
Suffix:
Gender:M
Credentials:MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 745043
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80006-5043
Mailing Address - Country:US
Mailing Address - Phone:970-691-5914
Mailing Address - Fax:
Practice Address - Street 1:948 NORTH ST STE 6
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3385
Practice Address - Country:US
Practice Address - Phone:303-545-5792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-08
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002567171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist