Provider Demographics
NPI:1245235779
Name:LACUNZA, CYNTHIA DIANE (DC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DIANE
Last Name:LACUNZA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:979 MISSION DE ORO DR
Mailing Address - Street 2:STE C
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-3852
Mailing Address - Country:US
Mailing Address - Phone:530-222-6510
Mailing Address - Fax:530-221-9440
Practice Address - Street 1:979 MISSION DE ORO DR
Practice Address - Street 2:STE C
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-3852
Practice Address - Country:US
Practice Address - Phone:530-222-6510
Practice Address - Fax:530-221-9440
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 24818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0248180Medicare ID - Type Unspecified