Provider Demographics
NPI:1851865489
Name:KACZMAR, JOAN (LAC)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:KACZMAR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6611 FOLSOM AUBURN RD STE I
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-2100
Mailing Address - Country:US
Mailing Address - Phone:530-318-4449
Mailing Address - Fax:
Practice Address - Street 1:6611 FOLSOM AUBURN RD STE I
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2100
Practice Address - Country:US
Practice Address - Phone:530-318-4449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18359171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist