Provider Demographics
NPI:1588797088
Name:ROSE, RACHAEL LEE (LAC)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:LEE
Last Name:ROSE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:LEE
Other - Last Name:SYLVESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:2931 W 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-4650
Mailing Address - Country:US
Mailing Address - Phone:303-480-0080
Mailing Address - Fax:
Practice Address - Street 1:2931 W 23RD AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-4650
Practice Address - Country:US
Practice Address - Phone:303-480-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO981171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist