Provider Demographics
NPI:1952687535
Name:SALAZAR, ALFONSO (LAC)
Entity Type:Individual
Prefix:MR
First Name:ALFONSO
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15187 E LOUISIANA DR
Mailing Address - Street 2:UNIT # A
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-7772
Mailing Address - Country:US
Mailing Address - Phone:720-227-4151
Mailing Address - Fax:
Practice Address - Street 1:6795 E TENNESSEE AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1614
Practice Address - Country:US
Practice Address - Phone:720-227-4151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1723171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist