Provider Demographics
NPI:1942441779
Name:HANDLIN, JACK (LAC)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:
Last Name:HANDLIN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7774 NE 122ND LN
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2436
Mailing Address - Country:US
Mailing Address - Phone:206-227-7541
Mailing Address - Fax:
Practice Address - Street 1:7774 NE 122ND LN
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2436
Practice Address - Country:US
Practice Address - Phone:206-227-7541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60070762171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist