Provider Demographics
NPI:1639682727
Name:PLACHTA, JACQUELINE (BSC, MAC, DIPL AC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:PLACHTA
Suffix:
Gender:F
Credentials:BSC, MAC, DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68B FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2129
Mailing Address - Country:US
Mailing Address - Phone:954-612-0039
Mailing Address - Fax:
Practice Address - Street 1:98 MAINE ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2031
Practice Address - Country:US
Practice Address - Phone:954-612-0039
Practice Address - Fax:954-612-0039
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC570171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist