Healthcare Provider Details

I. General information

NPI: 1285128231
Provider Name (Legal Business Name): DANIEL VACCARI LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3314 MESA RD
COLORADO SPRINGS CO
80904-1036
US

IV. Provider business mailing address

459 WINDCHIME PL
COLORADO SPRINGS CO
80919-1984
US

V. Phone/Fax

Practice location:
  • Phone: 719-520-4988
  • Fax:
Mailing address:
  • Phone: 985-778-5430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU.0002823
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: