Healthcare Provider Details

I. General information

NPI: 1174829659
Provider Name (Legal Business Name): MARIANNE FIKE M.AC., LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2011
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32895 COASTAL HWY SUITE 202
BETHANY BEACH DE
19930-3782
US

IV. Provider business mailing address

31388 DOGWOOD ESTATES DR
DAGSBORO DE
19939-4054
US

V. Phone/Fax

Practice location:
  • Phone: 302-236-5385
  • Fax:
Mailing address:
  • Phone: 302-236-5385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberCQ-0000015
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: