Provider Demographics
NPI:1609151281
Name:HAUSER, JEFF (MAOM, LAC)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:HAUSER
Suffix:
Gender:M
Credentials:MAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3352
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-4431
Mailing Address - Country:US
Mailing Address - Phone:360-427-7461
Mailing Address - Fax:360-427-7680
Practice Address - Street 1:1061 SE STATE ROUTE 3
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-9195
Practice Address - Country:US
Practice Address - Phone:360-427-7461
Practice Address - Fax:360-427-7680
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60219221171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1093002602OtherGROUP NPI