Provider Demographics
NPI:1629574421
Name:CARDELLINI, MEGAN (LAC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:CARDELLINI
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 1:195 S PENNSYLVANIA ST APT 301
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-1950
Mailing Address - Country:US
Mailing Address - Phone:303-903-4119
Mailing Address - Fax:
Practice Address - Street 1:827 N GRANT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2902
Practice Address - Country:US
Practice Address - Phone:303-903-4119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC185247171100000X
COACU.0002447171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty