Provider Demographics
NPI:1275033680
Name:DAUTRICH, ELIZABETH KATIE (LAC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KATIE
Last Name:DAUTRICH
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 1:203 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-3840
Mailing Address - Country:US
Mailing Address - Phone:970-462-8646
Mailing Address - Fax:
Practice Address - Street 1:805 W TOMICHI AVE
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-3477
Practice Address - Country:US
Practice Address - Phone:970-462-8646
Practice Address - Fax:970-462-8646
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU1849171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist