Provider Demographics
NPI:1427224195
Name:PIETSCH, AUGUSTUS SCOTT (LAC)
Entity Type:Individual
Prefix:MR
First Name:AUGUSTUS
Middle Name:SCOTT
Last Name:PIETSCH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6560 W EMERALD ST STE 124
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8781
Mailing Address - Country:US
Mailing Address - Phone:208-343-0112
Mailing Address - Fax:208-323-9909
Practice Address - Street 1:6560 W EMERALD ST STE 124
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8781
Practice Address - Country:US
Practice Address - Phone:208-343-0112
Practice Address - Fax:208-323-9909
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACU-138171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist