Healthcare Provider Details

I. General information

NPI: 1750298428
Provider Name (Legal Business Name): ALLIE WEISS DACCHM, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5442 LA JOLLA BLVD
LA JOLLA CA
92037-7648
US

IV. Provider business mailing address

5442 LA JOLLA BLVD
LA JOLLA CA
92037-7648
US

V. Phone/Fax

Practice location:
  • Phone: 847-826-1398
  • Fax:
Mailing address:
  • Phone: 847-826-1398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number20722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: