Provider Demographics
NPI:1821282815
Name:CHACON, LAURA MARCELA (LIC ACUPUNCTURIST)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MARCELA
Last Name:CHACON
Suffix:
Gender:F
Credentials:LIC ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2292 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3509
Mailing Address - Country:US
Mailing Address - Phone:786-474-5705
Mailing Address - Fax:
Practice Address - Street 1:2292 CORAL WAY
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-3509
Practice Address - Country:US
Practice Address - Phone:786-474-5705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-01
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2395171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist