Provider Demographics
NPI:1508209636
Name:DAMRON, ALYSSA (LAC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:DAMRON
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 1:15792 E PURDUE DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-2551
Mailing Address - Country:US
Mailing Address - Phone:308-631-0087
Mailing Address - Fax:
Practice Address - Street 1:10964 S PIKES PEAK DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-7327
Practice Address - Country:US
Practice Address - Phone:308-631-0087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU1853171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist