Provider Demographics
NPI:1477870848
Name:GREGORY, JULIAN DAVID II (LAC)
Entity Type:Individual
Prefix:MR
First Name:JULIAN
Middle Name:DAVID
Last Name:GREGORY
Suffix:II
Gender:M
Credentials:LAC
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Mailing Address - Street 1:10002 158TH ST E
Mailing Address - Street 2:APT #1
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-8922
Mailing Address - Country:US
Mailing Address - Phone:360-981-1626
Mailing Address - Fax:360-698-6499
Practice Address - Street 1:10002 158TH ST E
Practice Address - Street 2:APARTMENT #1
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-8922
Practice Address - Country:US
Practice Address - Phone:360-981-1626
Practice Address - Fax:360-698-6499
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAC60069233171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist