Provider Demographics
NPI:1619329877
Name:O'NEILL, JACY (LAC)
Entity Type:Individual
Prefix:
First Name:JACY
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S 24TH ST W STE 310
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6467
Mailing Address - Country:US
Mailing Address - Phone:406-272-0474
Mailing Address - Fax:
Practice Address - Street 1:1001 S 24TH ST W STE 310
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6467
Practice Address - Country:US
Practice Address - Phone:406-272-0474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2018-04-27
Deactivation Date:2018-04-06
Deactivation Code:
Reactivation Date:2018-04-25
Provider Licenses
StateLicense IDTaxonomies
MT60009171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist