Provider Demographics
NPI:1821314329
Name:MACNAB, CHANELLE CAROLYN (LAC)
Entity Type:Individual
Prefix:
First Name:CHANELLE
Middle Name:CAROLYN
Last Name:MACNAB
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 1497
Mailing Address - Street 2:
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-8143
Mailing Address - Country:US
Mailing Address - Phone:970-239-0015
Mailing Address - Fax:
Practice Address - Street 1:100 W COLORADO AVE
Practice Address - Street 2:SUITE 229
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435
Practice Address - Country:US
Practice Address - Phone:970-239-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1514171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist