Provider Demographics
NPI:1710471180
Name:THACKER, SONYA JENNIFER (LAC)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:JENNIFER
Last Name:THACKER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:SONJA
Other - Middle Name:
Other - Last Name:THACKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:2361 S FLANDERS ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-9456
Mailing Address - Country:US
Mailing Address - Phone:720-288-7625
Mailing Address - Fax:
Practice Address - Street 1:13731 E RICE PL STE 101
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-1076
Practice Address - Country:US
Practice Address - Phone:720-288-7625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0001988171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist