Provider Demographics
NPI:1730440595
Name:DELUCA, RACHAEL MARIE (DOM, LAC)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:MARIE
Last Name:DELUCA
Suffix:
Gender:F
Credentials:DOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W 39TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3858
Mailing Address - Country:US
Mailing Address - Phone:816-462-8062
Mailing Address - Fax:
Practice Address - Street 1:1001 W 39TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3858
Practice Address - Country:US
Practice Address - Phone:816-462-8062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012033137171100000X
NM1069171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist