Individual
DIRK MCCUISTION
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.M.T.
Contact information
Practice address
1640 BROADWAY, BOULDER, CO 80302-6219
(303) 938-0388
Mailing address
1640 BROADWAY, BOULDER, CO 80302-6219
(303) 938-0388
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT.0010742
CO
Other
Enumeration date
04/15/2015
Last updated
04/15/2015
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