Provider Demographics
NPI:1679839476
Name:RAGAN, COLLEEN (LAC, DIPLAC)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:
Last Name:RAGAN
Suffix:
Gender:F
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ST. FRANCIS STREET
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701
Mailing Address - Country:US
Mailing Address - Phone:605-791-1838
Mailing Address - Fax:605-791-1335
Practice Address - Street 1:10 ST. FRANCIS STREET
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-791-1838
Practice Address - Fax:605-791-1335
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1282171100000X
FL28690171100000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist