Provider Demographics
NPI:1104272053
Name:NEWALL, EDITH (LAC)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:NEWALL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9777 S YOSEMITE ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-3191
Mailing Address - Country:US
Mailing Address - Phone:720-560-3083
Mailing Address - Fax:877-613-8702
Practice Address - Street 1:9777 S YOSEMITE ST
Practice Address - Street 2:SUITE 110
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-3191
Practice Address - Country:US
Practice Address - Phone:720-560-3083
Practice Address - Fax:877-613-8702
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO0001885171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist