Provider Demographics
NPI:1578823316
Name:HENCKEL, CHRISTINE KIM (LAC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:KIM
Last Name:HENCKEL
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 1:21A LOWRY CT
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-9340
Mailing Address - Country:US
Mailing Address - Phone:201-602-8646
Mailing Address - Fax:
Practice Address - Street 1:21A LOWRY CT
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-9340
Practice Address - Country:US
Practice Address - Phone:201-602-8646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-28
Last Update Date:2012-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00089900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist