Healthcare Provider Details

I. General information

NPI: 1306492418
Provider Name (Legal Business Name): CHALIYAH PENICK M.AC., L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ROUTE 73 N STE I
MARLTON NJ
08053-1283
US

IV. Provider business mailing address

521 ERIAL RD
PINE HILL NJ
08021-6301
US

V. Phone/Fax

Practice location:
  • Phone: 215-275-6990
  • Fax: 856-494-1924
Mailing address:
  • Phone: 856-534-6282
  • Fax: 856-627-4556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: