Provider Demographics
NPI:1154442218
Name:KIRKPATRICK, REGIS L (LIC AC)
Entity Type:Individual
Prefix:
First Name:REGIS
Middle Name:L
Last Name:KIRKPATRICK
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CANYON RANCH
Mailing Address - Street 2:165 KEMBLE STREET - H&H DEPT.
Mailing Address - City:LENOX
Mailing Address - State:MA
Mailing Address - Zip Code:02140
Mailing Address - Country:US
Mailing Address - Phone:413-637-4400
Mailing Address - Fax:
Practice Address - Street 1:CANYON RANCH
Practice Address - Street 2:165 KEMBLE STREET - H&H DEPT.
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:02140
Practice Address - Country:US
Practice Address - Phone:413-637-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA321171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist