Provider Demographics
NPI:1619338191
Name:MACEACHERN, JOLEEN MARIE (LAC)
Entity Type:Individual
Prefix:
First Name:JOLEEN
Middle Name:MARIE
Last Name:MACEACHERN
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 1:1208 STONEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-8125
Mailing Address - Country:US
Mailing Address - Phone:805-698-5842
Mailing Address - Fax:805-735-1252
Practice Address - Street 1:104 S C ST
Practice Address - Street 2:SUITE B
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6924
Practice Address - Country:US
Practice Address - Phone:805-698-5842
Practice Address - Fax:805-735-1252
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8976171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist