Provider Demographics
NPI:1265320030
Name:CHACON, DOMONIQUE LORNA (IBCLC)
Entity type:Individual
Prefix:
First Name:DOMONIQUE
Middle Name:LORNA
Last Name:CHACON
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-5607
Mailing Address - Country:US
Mailing Address - Phone:720-314-7992
Mailing Address - Fax:
Practice Address - Street 1:3200 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-5607
Practice Address - Country:US
Practice Address - Phone:720-314-7992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-318939174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN