Provider Demographics
NPI:1407486681
Name:STACY JANE KLUCK, L.AC PLLC
Entity Type:Organization
Organization Name:STACY JANE KLUCK, L.AC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:KLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, LMT, CHTP
Authorized Official - Phone:512-383-6359
Mailing Address - Street 1:3810 MEDICAL PKWY STE 231
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-4014
Mailing Address - Country:US
Mailing Address - Phone:512-383-6359
Mailing Address - Fax:
Practice Address - Street 1:3810 MEDICAL PKWY STE 231
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-4014
Practice Address - Country:US
Practice Address - Phone:512-383-6359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1982945325OtherINDIVIDUAL PRACTITIONER NPI STACY JANE KLUCK