Healthcare Provider Details

I. General information

NPI: 1275774622
Provider Name (Legal Business Name): MICHAEL FRANCIS KLEINERT L.AC., ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 N EL CAMINO REAL SUITE 406
ENCINITAS CA
92024-2811
US

IV. Provider business mailing address

317 N EL CAMINO REAL SUITE 406
ENCINITAS CA
92024-2811
US

V. Phone/Fax

Practice location:
  • Phone: 760-632-1442
  • Fax:
Mailing address:
  • Phone: 760-632-1442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00074800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number12165
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: