Healthcare Provider Details

I. General information

NPI: 1437680436
Provider Name (Legal Business Name): TODD GEORGE LAC, MSOM, DIPL OM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S MCDOWELL ST SUITE 907
CHARLOTTE NC
28204-2623
US

IV. Provider business mailing address

301 S MCDOWELL ST SUITE 907
CHARLOTTE NC
28204-2623
US

V. Phone/Fax

Practice location:
  • Phone: 704-333-8899
  • Fax: 704-333-8090
Mailing address:
  • Phone: 704-333-8899
  • Fax: 704-333-8090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number371
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: