Provider Demographics
NPI:1073600375
Name:FROSTAD, JOHN P (LAC, EAMP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:P
Last Name:FROSTAD
Suffix:
Gender:M
Credentials:LAC, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 MERIDIAN AVE E
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98371-2613
Mailing Address - Country:US
Mailing Address - Phone:253-927-5905
Mailing Address - Fax:253-321-0219
Practice Address - Street 1:3217 MERIDIAN AVE E
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98371-2613
Practice Address - Country:US
Practice Address - Phone:253-927-5905
Practice Address - Fax:253-321-0219
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC366171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist