Provider Demographics
NPI:1780063206
Name:ACKERMAN, MICHAEL C (LAC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:ACKERMAN
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 1:2013 2ND AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-1780
Mailing Address - Country:US
Mailing Address - Phone:763-477-1338
Mailing Address - Fax:
Practice Address - Street 1:2013 2ND AVE STE 10
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-1780
Practice Address - Country:US
Practice Address - Phone:763-477-1338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1738171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist