Provider Demographics
NPI:1144565417
Name:DUCHNOWSKI, NICHOLAS LENARD (LAC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:LENARD
Last Name:DUCHNOWSKI
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 1:311 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3007
Mailing Address - Country:US
Mailing Address - Phone:502-939-0681
Mailing Address - Fax:
Practice Address - Street 1:311 WALLACE AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3007
Practice Address - Country:US
Practice Address - Phone:502-939-0681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15067171100000X
KYTAC93171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist