MEDICARE: DR. CAMILLE ALISSA THENARD DACCHM,DIPL.AC.,L.AC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC70083799	WA

General Provider Information

NPI Number	:	1245183078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAMILLE ALISSA THENARD DACCHM,DIPL.AC.,L.AC

Provider Business Mailing Address
First Line	:	6413 57TH CT SE
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98513-4187
Country	:	US
Telephone Number	:	714-642-1402
Fax Number	:

Provider Business Practice Location Address
First Line	:	4007 BRIDGEPORT WAY W STE C
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4330
Country	:	US
Telephone Number	:	253-242-3661
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2026
Last Update Date	:	06/05/2026

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