Provider Demographics
NPI:1417320755
Name:STARBUCK, JAMISON (ND)
Entity Type:Individual
Prefix:DR
First Name:JAMISON
Middle Name:
Last Name:STARBUCK
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S RESERVE ST STE J
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-4704
Mailing Address - Country:US
Mailing Address - Phone:406-549-0005
Mailing Address - Fax:406-549-1753
Practice Address - Street 1:1300 S RESERVE ST STE J
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4704
Practice Address - Country:US
Practice Address - Phone:406-549-0005
Practice Address - Fax:406-549-1753
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT24175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath