Provider Demographics
NPI:1689800534
Name:LOURIE, CAROL (ND, LAC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:LOURIE
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 PAGE ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-1326
Mailing Address - Country:US
Mailing Address - Phone:510-526-2028
Mailing Address - Fax:510-526-2032
Practice Address - Street 1:776 PAGE ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-1326
Practice Address - Country:US
Practice Address - Phone:510-526-2028
Practice Address - Fax:510-526-2032
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3404171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist