Provider Demographics
NPI:1790047199
Name:ELECZKO, JAMES MICHAEL (LAC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:ELECZKO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3948 BROWNING PL STE 204
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6512
Mailing Address - Country:US
Mailing Address - Phone:919-260-4104
Mailing Address - Fax:919-400-4232
Practice Address - Street 1:3948 BROWNING PL STE 204
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6512
Practice Address - Country:US
Practice Address - Phone:919-260-4104
Practice Address - Fax:919-400-4232
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC577171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist