Provider Demographics
NPI:1114094232
Name:MEDINA, JEFFREY DON (LAC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DON
Last Name:MEDINA
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 1:438 SW 347TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-8352
Mailing Address - Country:US
Mailing Address - Phone:253-332-5610
Mailing Address - Fax:
Practice Address - Street 1:32040 23RD AVE S
Practice Address - Street 2:SUITE 8
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6031
Practice Address - Country:US
Practice Address - Phone:253-529-1935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002777171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist