Provider Demographics
NPI:1174758759
Name:MORGAN, KATHRYN (DIPL OM, LAC)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:DIPL OM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3206
Mailing Address - Country:US
Mailing Address - Phone:303-775-1600
Mailing Address - Fax:
Practice Address - Street 1:3400 TABLE MESA DR
Practice Address - Street 2:SUITE 204
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5869
Practice Address - Country:US
Practice Address - Phone:303-775-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1413171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist