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1154595635 NPI number — HENRY TODD FLUCK M.AC, L.AC, DIPL.AC

NPI Number: 1154595635
Health Care Provider/Practitioner: HENRY TODD FLUCK M.AC, L.AC, DIPL.AC

Information about “1154595635” NPI (HENRY TODD FLUCK M.AC, L.AC, DIPL.AC) exists in 1154595635 in HTML format HTML  |  1154595635 in plain Text format TXT  |  1154595635 in PDF (Portable Document Format) PDF  |  1154595635 in an XML format XML  formats.

NPI Number : 1154595635 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1154595635",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FLUCK",
    "FirstName": "HENRY",
    "MiddleName": "TODD",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "M.AC, L.AC, DIPL.AC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "148 COLONY TRL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MARLTON",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "08053-5108",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "856-912-8219",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5000 SAGEMORE DR",
    "SecondLinePracticeLocationAddress": "SUITE 200",
    "PracticeLocationAddressCityName": "MARLTON",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "08053-4307",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "856-912-8219",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/16/2008",
    "LastUpdateDate": "02/05/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "225700000X",
          "TaxonomyName": "Massage Therapist",
          "LicenseNumber": "18KT00876800",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "171100000X",
          "TaxonomyName": "Acupuncturist",
          "LicenseNumber": "25MZ00123000",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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