Healthcare Provider Details

I. General information

NPI: 1053405902
Provider Name (Legal Business Name): MICHEL P CZEHATOWSKI L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 HARTNELL AVE
REDDING CA
96002-1842
US

IV. Provider business mailing address

PO BOX 493151
REDDING CA
96049-3151
US

V. Phone/Fax

Practice location:
  • Phone: 530-223-4849
  • Fax:
Mailing address:
  • Phone: 530-223-4849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: