Provider Demographics
NPI:1487964912
Name:WILLIAMS, MATTHEW (MS TCM LAC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MS TCM LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35657 RAINLEAF CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:CO
Mailing Address - Zip Code:80107-7855
Mailing Address - Country:US
Mailing Address - Phone:303-905-1730
Mailing Address - Fax:
Practice Address - Street 1:3865 CHERRY CREEK DRIVE NORTH
Practice Address - Street 2:SUITE 250
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209
Practice Address - Country:US
Practice Address - Phone:303-377-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1582171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist