Provider Demographics
NPI:1619110756
Name:JECMEN, MICHAEL CORY (MAC, LAC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CORY
Last Name:JECMEN
Suffix:
Gender:M
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:41869 DUBLANE PL
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-8038
Mailing Address - Country:US
Mailing Address - Phone:240-498-9979
Mailing Address - Fax:
Practice Address - Street 1:4701 SANGAMORE RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20816-2508
Practice Address - Country:US
Practice Address - Phone:240-507-5110
Practice Address - Fax:844-682-8102
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDUO1732171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist