Provider Demographics
NPI:1134405301
Name:BARLOW, NICHOLAS JAE (LAC)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:JAE
Last Name:BARLOW
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 1:8205 SANTA MONICA BLVD #1-118
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046
Mailing Address - Country:US
Mailing Address - Phone:310-425-2793
Mailing Address - Fax:
Practice Address - Street 1:636 N ALMONT DR
Practice Address - Street 2:STE A
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-5600
Practice Address - Country:US
Practice Address - Phone:310-425-2793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 14414171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist