Provider Demographics
NPI:1174289169
Name:MOHLER, NATHANIEL (DACM, LAC)
Entity type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:
Last Name:MOHLER
Suffix:
Gender:M
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11221 BILLINGS AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-9611
Mailing Address - Country:US
Mailing Address - Phone:303-801-5131
Mailing Address - Fax:
Practice Address - Street 1:6630 GUNPARK DR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3398
Practice Address - Country:US
Practice Address - Phone:303-801-5131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-13
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0001698171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist