Provider Demographics
NPI:1578721098
Name:SMITH, JEWELL (MS,LAC, LMP)
Entity Type:Individual
Prefix:
First Name:JEWELL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS,LAC, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2376 MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-8605
Mailing Address - Country:US
Mailing Address - Phone:360-384-2900
Mailing Address - Fax:360-384-2955
Practice Address - Street 1:2376 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-8605
Practice Address - Country:US
Practice Address - Phone:360-384-2900
Practice Address - Fax:360-384-2955
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002409171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty