Provider Demographics
NPI:1154595635
Name:FLUCK, HENRY TODD (MAC, LAC, DIPLAC)
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:TODD
Last Name:FLUCK
Suffix:
Gender:M
Credentials:MAC, LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 COLONY TRL
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-5108
Mailing Address - Country:US
Mailing Address - Phone:856-912-8219
Mailing Address - Fax:
Practice Address - Street 1:5000 SAGEMORE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4307
Practice Address - Country:US
Practice Address - Phone:856-912-8219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00876800225700000X
NJ25MZ00123000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist