Provider Demographics
NPI:1487724449
Name:LAM, MARCO (LAC)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:
Last Name:LAM
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 1:2516 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-4111
Mailing Address - Country:US
Mailing Address - Phone:303-444-2357
Mailing Address - Fax:303-444-2357
Practice Address - Street 1:2516 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4111
Practice Address - Country:US
Practice Address - Phone:303-444-2357
Practice Address - Fax:303-444-2357
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO791171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist