Healthcare Provider Details

I. General information

NPI: 1215216320
Provider Name (Legal Business Name): KYLA RACHEL BATES LA.C. DIPLO.OM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2011
Last Update Date: 08/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9075 FORSSTROM DR
LONETREE CO
80124-6737
US

IV. Provider business mailing address

1190 BIRCH ST 308
DENVER CO
80220-6214
US

V. Phone/Fax

Practice location:
  • Phone: 303-470-1995
  • Fax:
Mailing address:
  • Phone: 720-401-0346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1693
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: