Provider Demographics
NPI:1881473213
Name:SHULL, KAELY MARIE (LAC, DIPL OM, ADS)
Entity type:Individual
Prefix:
First Name:KAELY
Middle Name:MARIE
Last Name:SHULL
Suffix:
Gender:F
Credentials:LAC, DIPL OM, ADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 PEAR LAKE WAY
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-2637
Mailing Address - Country:US
Mailing Address - Phone:720-308-9737
Mailing Address - Fax:
Practice Address - Street 1:1148 W DILLON RD STE 1
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1298
Practice Address - Country:US
Practice Address - Phone:303-578-0869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2647171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist