Provider Demographics
NPI:1790082840
Name:KEELER, JOSH (MAC, LAC, LMP)
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:
Last Name:KEELER
Suffix:
Gender:M
Credentials:MAC, LAC, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 QUEEN ANNE AVE. N.
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109
Mailing Address - Country:US
Mailing Address - Phone:206-293-3538
Mailing Address - Fax:
Practice Address - Street 1:2550 QUEEN ANNE AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-1819
Practice Address - Country:US
Practice Address - Phone:206-293-3538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000384171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist