Provider Demographics
NPI:1669418653
Name:KEIGHER MAC., MARYBETH (ACUPUNCTURE MAC)
Entity type:Individual
Prefix:MRS
First Name:MARYBETH
Middle Name:
Last Name:KEIGHER MAC.
Suffix:
Gender:F
Credentials:ACUPUNCTURE MAC
Other - Prefix:MRS
Other - First Name:MARYBETH
Other - Middle Name:
Other - Last Name:FRITTER M.AC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACUPUNCTURIST MAC
Mailing Address - Street 1:3166 8TH ST
Mailing Address - Street 2:#1
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2516
Mailing Address - Country:US
Mailing Address - Phone:303-440-5514
Mailing Address - Fax:303-440-5514
Practice Address - Street 1:3166 8TH ST
Practice Address - Street 2:#1
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2516
Practice Address - Country:US
Practice Address - Phone:303-440-5514
Practice Address - Fax:303-440-5514
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist