Healthcare Provider Details

I. General information

NPI: 1235353905
Provider Name (Legal Business Name): CONSTANCE COLTON HERRICK L.AC, DIPL. O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 GREENBANK AVE
PIEDMONT CA
94611-4335
US

IV. Provider business mailing address

147 GREENBANK AVE
PIEDMONT CA
94611-4335
US

V. Phone/Fax

Practice location:
  • Phone: 510-652-7090
  • Fax: 510-652-3429
Mailing address:
  • Phone: 510-652-7090
  • Fax: 510-652-3429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: