Provider Demographics
NPI:1891389102
Name:KULACKOSKI, JAMES ALLEN (LAC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALLEN
Last Name:KULACKOSKI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3067 N HACKETT AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-3445
Mailing Address - Country:US
Mailing Address - Phone:312-545-6306
Mailing Address - Fax:
Practice Address - Street 1:3067 N HACKETT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-3445
Practice Address - Country:US
Practice Address - Phone:312-545-6306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI98955171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty