Provider Demographics
NPI:1356693295
Name:GIRARD, DELORECE LARIE (DOM, AP)
Entity type:Individual
Prefix:DR
First Name:DELORECE
Middle Name:LARIE
Last Name:GIRARD
Suffix:
Gender:F
Credentials:DOM, AP
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Mailing Address - Street 1:296 DAKOTA DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507-2571
Mailing Address - Country:US
Mailing Address - Phone:970-462-7864
Mailing Address - Fax:970-254-1687
Practice Address - Street 1:115 N 5TH ST
Practice Address - Street 2:STE 330
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2667
Practice Address - Country:US
Practice Address - Phone:970-254-1686
Practice Address - Fax:970-254-1687
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL3096171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist