Provider Demographics
NPI:1326229154
Name:CARRICK, TERI LYN (L AC)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:LYN
Last Name:CARRICK
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16831 1/2 ALGONQUIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-3810
Mailing Address - Country:US
Mailing Address - Phone:714-474-4228
Mailing Address - Fax:
Practice Address - Street 1:16831 1/2 ALGONQUIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-3810
Practice Address - Country:US
Practice Address - Phone:714-474-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10784171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist