Provider Demographics
NPI:1578814851
Name:STEPHENS, MICHAH W (LAC)
Entity type:Individual
Prefix:MR
First Name:MICHAH
Middle Name:W
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1491 DENVER AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-5227
Mailing Address - Country:US
Mailing Address - Phone:970-663-2225
Mailing Address - Fax:970-593-6748
Practice Address - Street 1:1491 DENVER AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5227
Practice Address - Country:US
Practice Address - Phone:970-663-2225
Practice Address - Fax:970-593-6748
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO954171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist