Provider Demographics
NPI:1710120936
Name:FALLON, LIEUM ELIZABETH (LAC)
Entity Type:Individual
Prefix:
First Name:LIEUM
Middle Name:ELIZABETH
Last Name:FALLON
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 1:7154 ELDRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-5925
Mailing Address - Country:US
Mailing Address - Phone:303-476-3799
Mailing Address - Fax:
Practice Address - Street 1:7154 ELDRIDGE CT
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-5925
Practice Address - Country:US
Practice Address - Phone:303-476-3799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12895171100000X
CO1680171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist