Provider Demographics
NPI:1902138670
Name:KINGSLEY, MICHELE DIANE (LACDIPLOM)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:DIANE
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:LACDIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 W 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-1313
Mailing Address - Country:US
Mailing Address - Phone:303-408-2990
Mailing Address - Fax:
Practice Address - Street 1:3535 W 44TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-1313
Practice Address - Country:US
Practice Address - Phone:303-408-2990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1502171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist