Provider Demographics
NPI:1730884081
Name:HALLORAN, EILEEN (LAC)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:HALLORAN
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 1:15 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:NH
Mailing Address - Zip Code:03033-2123
Mailing Address - Country:US
Mailing Address - Phone:603-801-1672
Mailing Address - Fax:
Practice Address - Street 1:29 RIVERSIDE ST UNIT B
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-1396
Practice Address - Country:US
Practice Address - Phone:603-880-4150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH344171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist