Provider Demographics
NPI:1477501898
Name:BUSH, LILLIAN MARIE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:MARIE
Last Name:BUSH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5723 S FLORENCE ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3712
Mailing Address - Country:US
Mailing Address - Phone:303-888-3783
Mailing Address - Fax:303-770-1816
Practice Address - Street 1:8000 E PRENTICE AVE
Practice Address - Street 2:SUITE D 10
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2744
Practice Address - Country:US
Practice Address - Phone:303-888-3783
Practice Address - Fax:303-770-1816
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1079171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist