Provider Demographics
NPI:1356844328
Name:TRUCKEY, MICHELLE (DOM, LAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:TRUCKEY
Suffix:
Gender:F
Credentials:DOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 EUBANK BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-5310
Mailing Address - Country:US
Mailing Address - Phone:505-298-4325
Mailing Address - Fax:
Practice Address - Street 1:1012 EUBANK BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-5310
Practice Address - Country:US
Practice Address - Phone:505-298-4325
Practice Address - Fax:505-294-5407
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist