Provider Demographics
NPI:1780058768
Name:DENNIS, KALE LEE (LAC)
Entity type:Individual
Prefix:
First Name:KALE
Middle Name:LEE
Last Name:DENNIS
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 1:145 W SWALLOW RD STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2500
Mailing Address - Country:US
Mailing Address - Phone:989-884-4473
Mailing Address - Fax:
Practice Address - Street 1:145 W SWALLOW RD STE 102
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2500
Practice Address - Country:US
Practice Address - Phone:989-884-4473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002737171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist