Provider Demographics
NPI:1386278158
Name:FOLEY, ELEANOR J (LAC)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:J
Last Name:FOLEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6956 HEMLOCK AVE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403-2051
Mailing Address - Country:US
Mailing Address - Phone:630-607-9147
Mailing Address - Fax:
Practice Address - Street 1:53 OLD SOLOMONS ISLAND RD STE C
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3872
Practice Address - Country:US
Practice Address - Phone:410-263-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02700171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty