Provider Demographics
NPI:1215216320
Name:BATES, KYLA RACHEL (LAC DIPLOOM)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:RACHEL
Last Name:BATES
Suffix:
Gender:F
Credentials:LAC DIPLOOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 BIRCH ST
Mailing Address - Street 2:308
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-6214
Mailing Address - Country:US
Mailing Address - Phone:720-401-0346
Mailing Address - Fax:
Practice Address - Street 1:9075 FORSSTROM DR
Practice Address - Street 2:
Practice Address - City:LONETREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6737
Practice Address - Country:US
Practice Address - Phone:303-470-1995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-07
Last Update Date:2011-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1693171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist