Provider Demographics
NPI:1154763621
Name:FRANCIK, DANIEL FONTENOT (LAC MAOM)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:FONTENOT
Last Name:FRANCIK
Suffix:
Gender:M
Credentials:LAC MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 NW NYE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-3428
Mailing Address - Country:US
Mailing Address - Phone:281-224-5854
Mailing Address - Fax:
Practice Address - Street 1:745 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-3151
Practice Address - Country:US
Practice Address - Phone:509-332-5613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163255171100000X
WAAC60393129171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist