Provider Demographics
NPI:1356614929
Name:YANSICK, JAMES (DOM L AC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:YANSICK
Suffix:
Gender:M
Credentials:DOM L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MITCHELL TER
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-1129
Mailing Address - Country:US
Mailing Address - Phone:856-266-0063
Mailing Address - Fax:
Practice Address - Street 1:3100 QUAKERBRIDGE RD
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-1658
Practice Address - Country:US
Practice Address - Phone:609-584-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00030900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist