Provider Demographics
NPI:1144384140
Name:EWING, JEFF DRAKE (LAC)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:DRAKE
Last Name:EWING
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:DRAKE
Other - Middle Name:
Other - Last Name:EWING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:PO BOX 1472
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98041-1472
Mailing Address - Country:US
Mailing Address - Phone:206-310-3206
Mailing Address - Fax:425-641-7081
Practice Address - Street 1:13400 NE 20TH ST STE 28
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2023
Practice Address - Country:US
Practice Address - Phone:425-644-2056
Practice Address - Fax:425-641-7081
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002513171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist