Provider Demographics
NPI:1144497389
Name:DEKADT, JOHN S (LIC AC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:DEKADT
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 LANDER RD
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:MA
Mailing Address - Zip Code:01238-9240
Mailing Address - Country:US
Mailing Address - Phone:413-637-4400
Mailing Address - Fax:
Practice Address - Street 1:CANYON RANCH
Practice Address - Street 2:64 KEMBEL STREET
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:02140
Practice Address - Country:US
Practice Address - Phone:413-637-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA643171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist