Provider Demographics
NPI:1346571395
Name:LEAR, DAISY ELIZABETH (LAC)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:ELIZABETH
Last Name:LEAR
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 1:161 BERWICK AVENUE
Mailing Address - Street 2:P.O. BOX 735
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80520-0735
Mailing Address - Country:US
Mailing Address - Phone:303-587-3557
Mailing Address - Fax:303-833-4485
Practice Address - Street 1:161 BERWICK AVE.
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80520
Practice Address - Country:US
Practice Address - Phone:303-587-3557
Practice Address - Fax:303-833-4485
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO726171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist