Provider Demographics
NPI:1255188082
Name:DUCHAC, NECTARIOS
Entity type:Individual
Prefix:
First Name:NECTARIOS
Middle Name:
Last Name:DUCHAC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53404-2315
Mailing Address - Country:US
Mailing Address - Phone:262-734-4274
Mailing Address - Fax:
Practice Address - Street 1:1709 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53404-2315
Practice Address - Country:US
Practice Address - Phone:262-734-4274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1146175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath