Provider Demographics
NPI:1083065528
Name:SIEG, JUSTIN (DAOM, LAC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:SIEG
Suffix:
Gender:M
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 SISKIYOU BLVD
Mailing Address - Street 2:#104
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2452
Mailing Address - Country:US
Mailing Address - Phone:415-722-7161
Mailing Address - Fax:
Practice Address - Street 1:258 A ST
Practice Address - Street 2:#21
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1947
Practice Address - Country:US
Practice Address - Phone:415-722-7161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 15172171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist