Provider Demographics
NPI:1790810539
Name:DENNIS, CAROLYN R (MACOM, LAC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:R
Last Name:DENNIS
Suffix:
Gender:F
Credentials:MACOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 ELM ST
Mailing Address - Street 2:#4
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2745
Mailing Address - Country:US
Mailing Address - Phone:360-738-8519
Mailing Address - Fax:
Practice Address - Street 1:2500 ELM ST
Practice Address - Street 2:#4
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2745
Practice Address - Country:US
Practice Address - Phone:360-738-8519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002925171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist