Provider Demographics
NPI:1245556703
Name:DELOATCH, LAURA ANN (L AC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:DELOATCH
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-1611
Mailing Address - Country:US
Mailing Address - Phone:303-229-5261
Mailing Address - Fax:
Practice Address - Street 1:130 W SACKETT AVE UNIT D
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2008
Practice Address - Country:US
Practice Address - Phone:719-530-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1500171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist