Healthcare Provider Details

I. General information

NPI: 1881746436
Provider Name (Legal Business Name): GINA HALSEY LAC, DIPLOM (NCCAOM)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 W 6TH ST STE C
LAWRENCE KS
66049
US

IV. Provider business mailing address

2512 W 6TH ST STE C
LAWRENCE KS
66049-2441
US

V. Phone/Fax

Practice location:
  • Phone: 785-856-6789
  • Fax: 785-856-4050
Mailing address:
  • Phone: 785-856-6789
  • Fax: 785-856-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC5556
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2300043
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: