Provider Demographics
NPI:1821383092
Name:DECKER, KALEY JO (LAC, DIPL AC)
Entity Type:Individual
Prefix:
First Name:KALEY
Middle Name:JO
Last Name:DECKER
Suffix:
Gender:F
Credentials:LAC, DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-3107
Mailing Address - Country:US
Mailing Address - Phone:812-255-0277
Mailing Address - Fax:812-255-0272
Practice Address - Street 1:903 N 7TH ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-3107
Practice Address - Country:US
Practice Address - Phone:812-255-0277
Practice Address - Fax:812-255-0272
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000132A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist