Provider Demographics
NPI:1982026761
Name:PALACIOS, ANTONIO IGNACIO (EAMP)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:IGNACIO
Last Name:PALACIOS
Suffix:
Gender:M
Credentials:EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 159TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-4623
Mailing Address - Country:US
Mailing Address - Phone:206-453-8552
Mailing Address - Fax:
Practice Address - Street 1:14524 MAIN ST NE STE 117
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-8467
Practice Address - Country:US
Practice Address - Phone:206-453-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60404553171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist