Provider Demographics
NPI:1003879198
Name:SMITH, MICHELLE JOELLEN (L AC, DIPL AC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:JOELLEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:L AC, DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6119 S MOLINE WAY
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5846
Mailing Address - Country:US
Mailing Address - Phone:303-902-8685
Mailing Address - Fax:
Practice Address - Street 1:6119 S MOLINE WAY
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80111-5846
Practice Address - Country:US
Practice Address - Phone:303-902-8685
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1155171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist