Healthcare Provider Details

I. General information

NPI: 1295818011
Provider Name (Legal Business Name): LAUREN O'BRIEN BUCKLEY L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1153 S 8TH ST
PHILADELPHIA PA
19147-5132
US

IV. Provider business mailing address

1153 S 8TH ST
PHILADELPHIA PA
19147-5132
US

V. Phone/Fax

Practice location:
  • Phone: 215-279-3932
  • Fax:
Mailing address:
  • Phone: 215-279-3932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberKO-000520
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: