Individual
THOMAS LAVERNE BACHINSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
2101 KEN PRATT BLVD, SUITE 104, LONGMONT, CO 80501-6567
(303) 415-4157
(303) 776-3102
Mailing address
5450 WESTERN AVE, SUITE B, BOULDER, CO 80301-2709
(303) 415-4770
(303) 415-4769
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA.0000246
CO
363AM0700X
Medical Physician Assistant
Primary
PA.0000246
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07002462
—
CO
Enumeration date
10/17/2006
Last updated
08/24/2017
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