Provider Demographics
NPI:1467590570
Name:MALLORY, MARCIA A (LAC)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:A
Last Name:MALLORY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2693 N HIGHWAY 77 STE 2105
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-6168
Mailing Address - Country:US
Mailing Address - Phone:469-517-0683
Mailing Address - Fax:469-517-0683
Practice Address - Street 1:2693 N HIGHWAY 77 STE 2105
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-6168
Practice Address - Country:US
Practice Address - Phone:469-517-0683
Practice Address - Fax:469-517-0683
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC000794171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist