Provider Demographics
NPI:1134582760
Name:MILLIKEN, JACQUELINE GRACE (LAC)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:GRACE
Last Name:MILLIKEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 DICKSON DR APT 156
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4787
Mailing Address - Country:US
Mailing Address - Phone:330-329-2051
Mailing Address - Fax:
Practice Address - Street 1:2121 DICKSON DR APT 156
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4787
Practice Address - Country:US
Practice Address - Phone:330-329-2051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist