Provider Demographics
NPI:1053670067
Name:MCGIMSEY, JOHN CLARK (LAC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CLARK
Last Name:MCGIMSEY
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 1:705 NORTHEAST DR STE 14
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7431
Mailing Address - Country:US
Mailing Address - Phone:828-413-0567
Mailing Address - Fax:
Practice Address - Street 1:705 NORTHEAST DR STE 14
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7431
Practice Address - Country:US
Practice Address - Phone:828-413-0567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist