Provider Demographics
NPI:1871756320
Name:STERTZBACH, KARL TRAEGER (LAC)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:TRAEGER
Last Name:STERTZBACH
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 1:118 RING DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-2235
Mailing Address - Country:US
Mailing Address - Phone:928-300-2494
Mailing Address - Fax:
Practice Address - Street 1:1526 IDYLWILD RD
Practice Address - Street 2:SUITE B
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-2237
Practice Address - Country:US
Practice Address - Phone:928-300-2494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-04
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0539171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist