Provider Demographics
NPI:1477798510
Name:STICKLEY, KARL BRANDT III (LAC,)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:BRANDT
Last Name:STICKLEY
Suffix:III
Gender:M
Credentials:LAC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4300
Mailing Address - Country:US
Mailing Address - Phone:321-639-7802
Mailing Address - Fax:
Practice Address - Street 1:3010 FISKE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-4300
Practice Address - Country:US
Practice Address - Phone:321-639-7802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1752171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist