Healthcare Provider Details

I. General information

NPI: 1154595635
Provider Name (Legal Business Name): HENRY TODD FLUCK M.AC, L.AC, DIPL.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 SAGEMORE DR SUITE 200
MARLTON NJ
08053-4307
US

IV. Provider business mailing address

148 COLONY TRL
MARLTON NJ
08053-5108
US

V. Phone/Fax

Practice location:
  • Phone: 856-912-8219
  • Fax:
Mailing address:
  • Phone: 856-912-8219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00123000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT00876800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: