Provider Demographics
NPI:1295030443
Name:UNTCH, REANNON R (LAC)
Entity Type:Individual
Prefix:
First Name:REANNON
Middle Name:R
Last Name:UNTCH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:REANNON
Other - Middle Name:R
Other - Last Name:RUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:PO BOX 1423
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CO
Mailing Address - Zip Code:80446-1423
Mailing Address - Country:US
Mailing Address - Phone:970-281-3022
Mailing Address - Fax:
Practice Address - Street 1:55 FIRST ST.
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CO
Practice Address - Zip Code:80446
Practice Address - Country:US
Practice Address - Phone:970-281-3022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002306171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist