Provider Demographics
NPI:1639555337
Name:POTTER, WILLIAM (LAC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:POTTER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:1750 BARBARA LN
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1201
Mailing Address - Country:US
Mailing Address - Phone:312-961-2256
Mailing Address - Fax:
Practice Address - Street 1:1750 BARBARA LN
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1201
Practice Address - Country:US
Practice Address - Phone:312-961-2256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15829171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist