Provider Demographics
NPI:1760637508
Name:LAVALLEY, KRISTIE M (LAC)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:M
Last Name:LAVALLEY
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 1:190 N GRAND MESA DR
Mailing Address - Street 2:
Mailing Address - City:CEDAREDGE
Mailing Address - State:CO
Mailing Address - Zip Code:81413-8388
Mailing Address - Country:US
Mailing Address - Phone:970-856-4729
Mailing Address - Fax:970-856-4734
Practice Address - Street 1:190 N GRAND MESA DR
Practice Address - Street 2:
Practice Address - City:CEDAREDGE
Practice Address - State:CO
Practice Address - Zip Code:81413-8388
Practice Address - Country:US
Practice Address - Phone:970-856-4729
Practice Address - Fax:970-856-4734
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1293171100000X
TXAC00882171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist