Provider Demographics
NPI:1154929636
Name:RODRIGUEZ, MICHELE KAITLIN (MSOM, LAC, LMT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:KAITLIN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSOM, LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2690 VALMONT RD APT 2
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2951
Mailing Address - Country:US
Mailing Address - Phone:720-560-1401
Mailing Address - Fax:
Practice Address - Street 1:2690 VALMONT RD APT 2
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2951
Practice Address - Country:US
Practice Address - Phone:720-560-1401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002269171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist