Provider Demographics
NPI:1578713616
Name:LINQUIST, JEREMY EDWARD (LAC)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:EDWARD
Last Name:LINQUIST
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1140 N LAKE PARK BLVD
Mailing Address - Street 2:SUITE I
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-4100
Mailing Address - Country:US
Mailing Address - Phone:910-202-4718
Mailing Address - Fax:910-202-4718
Practice Address - Street 1:1140 N LAKE PARK BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:CAROLINA BEACH
Practice Address - State:NC
Practice Address - Zip Code:28428-4100
Practice Address - Country:US
Practice Address - Phone:910-202-4718
Practice Address - Fax:910-202-4718
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12576171100000X
NC566171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist