Provider Demographics
NPI:1164635751
Name:KACHUR, NADINE THERESA (LAC)
Entity Type:Individual
Prefix:MS
First Name:NADINE
Middle Name:THERESA
Last Name:KACHUR
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 1:3937 BAYO ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-2101
Mailing Address - Country:US
Mailing Address - Phone:510-336-2688
Mailing Address - Fax:
Practice Address - Street 1:3937 BAYO ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-2101
Practice Address - Country:US
Practice Address - Phone:510-336-2688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3050171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist