Healthcare Provider Details

I. General information

NPI: 1477044485
Provider Name (Legal Business Name): VALERIE LYVERS LAC, DIPL.OM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 SPRING ST STE 101
MOUNT PLEASANT WI
53406-2920
US

IV. Provider business mailing address

1401 WISCONSIN AVE
RACINE WI
53403-1980
US

V. Phone/Fax

Practice location:
  • Phone: 574-309-2966
  • Fax:
Mailing address:
  • Phone: 574-309-2966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1011-55
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: