Provider Demographics
NPI:1245770585
Name:KING, JONATHAN (EAMP)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2164 NE HOSTMARK ST
Mailing Address - Street 2:#24
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7503
Mailing Address - Country:US
Mailing Address - Phone:772-539-3421
Mailing Address - Fax:
Practice Address - Street 1:2164 NE HOSTMARK ST
Practice Address - Street 2:#24
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7503
Practice Address - Country:US
Practice Address - Phone:772-539-3421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60730946171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist