Provider Demographics
NPI:1467685768
Name:CHRISTINA JACKSON L.AC. AND ASSOCIATES
Entity Type:Organization
Organization Name:CHRISTINA JACKSON L.AC. AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:425-557-9519
Mailing Address - Street 1:120 1ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-3228
Mailing Address - Country:US
Mailing Address - Phone:425-557-9519
Mailing Address - Fax:425-557-0595
Practice Address - Street 1:120 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3228
Practice Address - Country:US
Practice Address - Phone:425-557-9519
Practice Address - Fax:425-557-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000265171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty