Provider Demographics
NPI:1427341304
Name:LICKER, AARON DAVID (LAC)
Entity type:Individual
Prefix:MR
First Name:AARON
Middle Name:DAVID
Last Name:LICKER
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 1:3520 ELIZABETH WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3428
Mailing Address - Country:US
Mailing Address - Phone:530-646-8789
Mailing Address - Fax:
Practice Address - Street 1:3520 ELIZABETH WAY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3428
Practice Address - Country:US
Practice Address - Phone:530-646-8789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14121171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist