Provider Demographics
NPI:1295091304
Name:TANK, ROBERT HENRY JR (LAC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:HENRY
Last Name:TANK
Suffix:JR
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W 8TH AVE # 101
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4332
Mailing Address - Country:US
Mailing Address - Phone:720-904-0937
Mailing Address - Fax:
Practice Address - Street 1:800 W 8TH AVE # 101
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4332
Practice Address - Country:US
Practice Address - Phone:720-904-0937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO526171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist