Provider Demographics
NPI:1548599624
Name:JACKMAN, GLORIA HELEN (MS LAC)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:HELEN
Last Name:JACKMAN
Suffix:
Gender:F
Credentials:MS LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SONOMA ROAD
Mailing Address - Street 2:CORTLANDT ACUPUNCTURE AND HERBOLOGY
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567
Mailing Address - Country:US
Mailing Address - Phone:914-293-7366
Mailing Address - Fax:
Practice Address - Street 1:3 SONOMA ROAD
Practice Address - Street 2:CORTLANDT ACUPUNCTURE AND HERBOLOGY
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567
Practice Address - Country:US
Practice Address - Phone:914-293-7366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003342-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist