Provider Demographics
NPI:1861807448
Name:KULASKI, DAWN (LAC)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:KULASKI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30382 PINE CREST DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-9527
Mailing Address - Country:US
Mailing Address - Phone:720-289-6604
Mailing Address - Fax:
Practice Address - Street 1:12211 W ALAMEDA PKWY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2866
Practice Address - Country:US
Practice Address - Phone:720-289-6604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0001952171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist