Provider Demographics
NPI:1629494927
Name:KORCZYK, KACY RAE (LAC)
Entity Type:Individual
Prefix:MISS
First Name:KACY
Middle Name:RAE
Last Name:KORCZYK
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 1:21 MALLARD CT
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3615
Mailing Address - Country:US
Mailing Address - Phone:304-890-8020
Mailing Address - Fax:
Practice Address - Street 1:21 MALLARD CT
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3615
Practice Address - Country:US
Practice Address - Phone:304-890-8020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV96223171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist