Provider Demographics
NPI:1255681201
Name:MCIVER, DOUGLAS STUART (LAC)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:STUART
Last Name:MCIVER
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 1:674 MOUL RD
Mailing Address - Street 2:
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-9508
Mailing Address - Country:US
Mailing Address - Phone:585-690-4224
Mailing Address - Fax:
Practice Address - Street 1:1387 FAIRPORT RD
Practice Address - Street 2:BUILDING 500, SUITE 520
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-2003
Practice Address - Country:US
Practice Address - Phone:585-690-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25004910171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist