Provider Demographics
NPI:1013419688
Name:STACK, SARAH LEWIS (LAC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LEWIS
Last Name:STACK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 12TH ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-0714
Mailing Address - Country:US
Mailing Address - Phone:704-564-6010
Mailing Address - Fax:
Practice Address - Street 1:720 14TH ST
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-1907
Practice Address - Country:US
Practice Address - Phone:720-593-9758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002335171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist