Provider Demographics
NPI:1033257662
Name:JACKSON, ADAM S (LAC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:S
Last Name:JACKSON
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 1:5800 SOUNDVIEW DR STE C101
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-2077
Mailing Address - Country:US
Mailing Address - Phone:253-858-9609
Mailing Address - Fax:
Practice Address - Street 1:5800 SOUNDVIEW DR STE C101
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-2077
Practice Address - Country:US
Practice Address - Phone:253-858-9609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00001996171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist