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1043418775 NPI number — CINDY FAE ICKE L.AC., O.M.D.

NPI Number: 1043418775
Health Care Provider/Practitioner: CINDY FAE ICKE L.AC., O.M.D.

Information about “1043418775” NPI (CINDY FAE ICKE L.AC., O.M.D.) exists in 1043418775 in HTML format HTML  |  1043418775 in plain Text format TXT  |  1043418775 in PDF (Portable Document Format) PDF  |  1043418775 in an XML format XML  formats.

NPI Number : 1043418775 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043418775",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ICKE",
    "FirstName": "CINDY",
    "MiddleName": "FAE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "L.AC., O.M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ICKE",
    "OtherFirstName": "CYNTHIA",
    "OtherMiddleName": "FAE",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "L.AC., O.M.D.",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "3532 19TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN FRANCISCO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "94110-1612",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "415-565-0658",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "760 MARKET ST",
    "SecondLinePracticeLocationAddress": "SUITE 759",
    "PracticeLocationAddressCityName": "SAN FRANCISCO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94102-2401",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "415-262-0083",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/03/2007",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "171100000X",
        "TaxonomyName": "Acupuncturist",
        "LicenseNumber": "AC 1508",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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