Provider Demographics
NPI:1740562644
Name:KELLEY, DEBORAH PAULINE (LAC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:PAULINE
Last Name:KELLEY
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:PO BOX 7275
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-0122
Mailing Address - Country:US
Mailing Address - Phone:720-936-4822
Mailing Address - Fax:720-328-8878
Practice Address - Street 1:8795 RALSTON RD
Practice Address - Street 2:127
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-2364
Practice Address - Country:US
Practice Address - Phone:720-936-4822
Practice Address - Fax:720-328-8878
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1701171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist