Provider Demographics
NPI:1689212755
Name:WORTHY, JACQUELINE E (ACUPUNCTURE)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:E
Last Name:WORTHY
Suffix:
Gender:F
Credentials:ACUPUNCTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 W 13 MILE RD APT 206
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-2948
Mailing Address - Country:US
Mailing Address - Phone:248-761-0623
Mailing Address - Fax:
Practice Address - Street 1:720 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1964
Practice Address - Country:US
Practice Address - Phone:248-733-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist