Provider Demographics
NPI:1306860606
Name:SALAS, TAWNYA M (LAC, MSOM)
Entity Type:Individual
Prefix:
First Name:TAWNYA
Middle Name:M
Last Name:SALAS
Suffix:
Gender:F
Credentials:LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 W D ST STE 100C
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-4430
Mailing Address - Country:US
Mailing Address - Phone:719-545-6189
Mailing Address - Fax:719-545-2807
Practice Address - Street 1:126 WEST D STREET
Practice Address - Street 2:SUITE 100C
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003
Practice Address - Country:US
Practice Address - Phone:719-545-6189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO869171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist