Provider Demographics
NPI:1124620380
Name:PRESTON, REBECCA (LAC, DIPLAC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:PRESTON
Suffix:
Gender:F
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26020 E DAVIES DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-6098
Mailing Address - Country:US
Mailing Address - Phone:954-540-9110
Mailing Address - Fax:
Practice Address - Street 1:26020 E DAVIES DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-6098
Practice Address - Country:US
Practice Address - Phone:954-540-9110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty