Individual
KELLY ROSE SHERIDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.AC.
Contact information
Practice address
2992 25TH ST, BOULDER, CO 80304-2808
(267) 760-0014
Mailing address
2992 25TH ST, BOULDER, CO 80304-2808
(267) 760-0014
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
ACU0002259
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
O564542
—
CO
Enumeration date
12/19/2016
Last updated
12/19/2016
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