Provider Demographics
NPI:1144264342
Name:MACISAAC, KAREN (LAC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MACISAAC
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:PO BOX 2878
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-2878
Mailing Address - Country:US
Mailing Address - Phone:808-329-4393
Mailing Address - Fax:808-329-4393
Practice Address - Street 1:75-5995 KUAKINI HWY
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2120
Practice Address - Country:US
Practice Address - Phone:808-329-4393
Practice Address - Fax:808-329-4393
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU 221171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist