Healthcare Provider Details

I. General information

NPI: 1376471250
Provider Name (Legal Business Name): AARON DETERDING LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 E 28TH AVE
DENVER CO
80205-4561
US

IV. Provider business mailing address

2322 MAGNOLIA ST
DENVER CO
80207-3503
US

V. Phone/Fax

Practice location:
  • Phone: 720-381-4165
  • Fax:
Mailing address:
  • Phone: 303-915-6939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU.0002996
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: