Provider Demographics
NPI:1164272704
Name:STESKAL, JACQUELINE (L AC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:STESKAL
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2036 SEPVIVA ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-1910
Mailing Address - Country:US
Mailing Address - Phone:215-264-2647
Mailing Address - Fax:
Practice Address - Street 1:1639 N HANCOCK ST STE 102
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-3133
Practice Address - Country:US
Practice Address - Phone:215-964-9056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001425171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist