Provider Demographics
NPI:1043484173
Name:ALCICI, ANDREA (LAC, MAOM)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:ALCICI
Suffix:
Gender:F
Credentials:LAC, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2758
Mailing Address - Country:US
Mailing Address - Phone:541-840-5352
Mailing Address - Fax:
Practice Address - Street 1:155 STRAWBERRY LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2758
Practice Address - Country:US
Practice Address - Phone:541-840-5352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01096171100000X
9310720100171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
9310720100OtherNCCA