Provider Demographics
NPI:1184652661
Name:SCHWARTZ, JEFFERY PARKER (LAC)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:PARKER
Last Name:SCHWARTZ
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 1:272 N FRONT ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4059
Mailing Address - Country:US
Mailing Address - Phone:910-200-5364
Mailing Address - Fax:910-251-7859
Practice Address - Street 1:272 N FRONT ST
Practice Address - Street 2:SUITE 220
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4059
Practice Address - Country:US
Practice Address - Phone:910-200-5364
Practice Address - Fax:910-251-7859
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC368171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist