Provider Demographics
NPI:1497146161
Name:STUART, JONATHAN (LAC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:STUART
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 DAIRY ASHFORD RD STE 120
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-5307
Mailing Address - Country:US
Mailing Address - Phone:832-819-0888
Mailing Address - Fax:
Practice Address - Street 1:955 DAIRY ASHFORD RD STE 120
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-5307
Practice Address - Country:US
Practice Address - Phone:832-819-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01548171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist