Provider Demographics
NPI:1891132122
Name:COYNER, SHARON J (LAC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:J
Last Name:COYNER
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 923
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-0923
Mailing Address - Country:US
Mailing Address - Phone:303-882-0477
Mailing Address - Fax:303-697-4357
Practice Address - Street 1:26291 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-8500
Practice Address - Country:US
Practice Address - Phone:303-882-0477
Practice Address - Fax:303-697-4357
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1657171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist