Provider Demographics
NPI:1215017249
Name:MCLAUGHLIN, JAMIE SIOUX (LAC)
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:SIOUX
Last Name:MCLAUGHLIN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:SUE
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DOM
Mailing Address - Street 1:6003 HARBOUR PARK DR.
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112
Mailing Address - Country:US
Mailing Address - Phone:804-739-7700
Mailing Address - Fax:804-745-7804
Practice Address - Street 1:6003 HARBOUR PARK DR.
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112
Practice Address - Country:US
Practice Address - Phone:804-739-7700
Practice Address - Fax:804-745-7804
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM740171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
9420365OtherPHCS
NMNMOORD90OtherBCBS