Provider Demographics
NPI:1275782708
Name:DE JONG, PAUL GJALT (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:GJALT
Last Name:DE JONG
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 GIRARD ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4004
Mailing Address - Country:US
Mailing Address - Phone:360-746-7167
Mailing Address - Fax:360-733-1165
Practice Address - Street 1:414 GIRARD ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4004
Practice Address - Country:US
Practice Address - Phone:360-746-7167
Practice Address - Fax:360-733-1165
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60020655175F00000X
WAAC60268883171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist