Provider Demographics
NPI:1013455617
Name:JUBAL J BEWICK EAMP, MSAOM PLLC
Entity Type:Organization
Organization Name:JUBAL J BEWICK EAMP, MSAOM PLLC
Other - Org Name:BLUE MOUNTAIN ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUBAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BEWICK
Authorized Official - Suffix:
Authorized Official - Credentials:EAMP, MSAOM
Authorized Official - Phone:509-876-4597
Mailing Address - Street 1:2200 MELROSE ST STE 9
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-1579
Mailing Address - Country:US
Mailing Address - Phone:509-876-4597
Mailing Address - Fax:509-876-4599
Practice Address - Street 1:2200 MELROSE ST STE 9
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-1579
Practice Address - Country:US
Practice Address - Phone:509-876-4597
Practice Address - Fax:509-876-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60511065171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty