Provider Demographics
NPI:1750677266
Name:YURCZYK-CAMPBELL, CYNTHIA L (MSOM, LAC, CMT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:YURCZYK-CAMPBELL
Suffix:
Gender:F
Credentials:MSOM, LAC, CMT
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:612 S WELLS ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-2159
Mailing Address - Country:US
Mailing Address - Phone:262-249-0770
Mailing Address - Fax:262-249-0770
Practice Address - Street 1:612 S WELLS ST
Practice Address - Street 2:SUITE B
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-2159
Practice Address - Country:US
Practice Address - Phone:262-249-0770
Practice Address - Fax:262-249-0770
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI382055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist