Provider Demographics
NPI:1124416706
Name:DREXLER, NICOLAS SEBASTIAN (LAC)
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:SEBASTIAN
Last Name:DREXLER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 MARCH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3368
Mailing Address - Country:US
Mailing Address - Phone:707-548-3978
Mailing Address - Fax:
Practice Address - Street 1:431 MARCH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3368
Practice Address - Country:US
Practice Address - Phone:707-548-3978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16244171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist