Provider Demographics
NPI:1366108490
Name:MOOSE, JULIE C (LAC, DIPLAC)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:C
Last Name:MOOSE
Suffix:
Gender:F
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 2ND ST NW STE C
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-4966
Mailing Address - Country:US
Mailing Address - Phone:828-855-3311
Mailing Address - Fax:
Practice Address - Street 1:419 2ND ST NW STE C
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-4966
Practice Address - Country:US
Practice Address - Phone:828-855-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2094171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist