Provider Demographics
NPI:1659320901
Name:COBB, MARY MELINDA (LAC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MELINDA
Last Name:COBB
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:4245 DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-1719
Mailing Address - Country:US
Mailing Address - Phone:303-887-8942
Mailing Address - Fax:303-422-1428
Practice Address - Street 1:4380 HARLAN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-5155
Practice Address - Country:US
Practice Address - Phone:303-887-8942
Practice Address - Fax:303-422-1428
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1154171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist