MEDICARE: JACQUELINE PLACHTA B.SC, M.AC, DIPL. 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	AC570	ME

General Provider Information

NPI Number	:	1639682727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE PLACHTA B.SC, M.AC, DIPL. AC

Provider Business Mailing Address
First Line	:	68B FEDERAL ST
Second Line	:
City	:	BRUNSWICK
State	:	ME
Zip	:	04011-2129
Country	:	US
Telephone Number	:	954-612-0039
Fax Number	:

Provider Business Practice Location Address
First Line	:	98 MAINE ST
Second Line	:
City	:	BRUNSWICK
State	:	ME
Zip	:	04011-2031
Country	:	US
Telephone Number	:	954-612-0039
Fax Number	:	954-612-0039

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

Provider Enumeration Date	:	11/10/2017
Last Update Date	:	11/10/2017

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