Provider Demographics
NPI:1902938350
Name:CLANCY, BENJAMEN P (LAC, DIPLAC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMEN
Middle Name:P
Last Name:CLANCY
Suffix:
Gender:M
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 1:4169 WESTPORT RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2747
Mailing Address - Country:US
Mailing Address - Phone:502-710-9088
Mailing Address - Fax:
Practice Address - Street 1:4169 WESTPORT RD
Practice Address - Street 2:SUITE 124
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2747
Practice Address - Country:US
Practice Address - Phone:502-710-9088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAC026171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist