Provider Demographics
NPI:1336788801
Name:WHEELER, CHERYL (LAC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:WHEELER
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 1:8199 WELBY RD APT 3206
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-5651
Mailing Address - Country:US
Mailing Address - Phone:303-868-1319
Mailing Address - Fax:
Practice Address - Street 1:8199 WELBY RD APT 3206
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-5651
Practice Address - Country:US
Practice Address - Phone:303-868-1319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002477171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COACU.0002477OtherDORA
COMT.0018198OtherDORA