Provider Demographics
NPI:1376318477
Name:KRIEGER, JEREMIAH (DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:
Last Name:KRIEGER
Suffix:
Gender:M
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-4206
Mailing Address - Country:US
Mailing Address - Phone:310-488-6188
Mailing Address - Fax:
Practice Address - Street 1:918 S ROBERTSON BLVD STE 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1611
Practice Address - Country:US
Practice Address - Phone:310-488-6188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9610171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist