Provider Demographics
NPI:1871871582
Name:MULL, MICHAEL (MSAC, DIPL, LACRMT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:MULL
Suffix:
Gender:M
Credentials:MSAC, DIPL, LACRMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 AVALON DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-6953
Mailing Address - Country:US
Mailing Address - Phone:720-434-6603
Mailing Address - Fax:
Practice Address - Street 1:648 AVALON DR
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-6953
Practice Address - Country:US
Practice Address - Phone:720-434-6603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO812225700000X
COACU.0002637171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist