Healthcare Provider Details

I. General information

NPI: 1205239258
Provider Name (Legal Business Name): THOMAS CHARLES FLACH JR. L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29135 HOOK CREEK RD
CEDAR GLEN CA
92321
US

IV. Provider business mailing address

PO BOX 1186
CEDAR GLEN CA
92321-1186
US

V. Phone/Fax

Practice location:
  • Phone: 858-761-7432
  • Fax:
Mailing address:
  • Phone: 858-760-7432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: