Healthcare Provider Details

I. General information

NPI: 1740230804
Provider Name (Legal Business Name): JULIE R SMITH LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 2ND AVE
LYONS CO
80540
US

IV. Provider business mailing address

PO BOX 1083
LYONS CO
80540
US

V. Phone/Fax

Practice location:
  • Phone: 303-775-2849
  • Fax:
Mailing address:
  • Phone: 303-775-2849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number463
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: