Provider Demographics
NPI:1346952637
Name:RUNDALL, LISA (DACM, L AC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:RUNDALL
Suffix:
Gender:F
Credentials:DACM, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 W 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-2706
Mailing Address - Country:US
Mailing Address - Phone:303-803-4625
Mailing Address - Fax:
Practice Address - Street 1:2150 W 29TH AVE STE 325
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3864
Practice Address - Country:US
Practice Address - Phone:303-803-4625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002698171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty