Provider Demographics
NPI:1285267468
Name:FLATER, DAVID LARRY (LAC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LARRY
Last Name:FLATER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 N 200 E APT 2
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4733
Mailing Address - Country:US
Mailing Address - Phone:801-725-3885
Mailing Address - Fax:
Practice Address - Street 1:761 W ANTELOPE DR
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1630
Practice Address - Country:US
Practice Address - Phone:801-779-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6054092-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist