Provider Demographics
NPI:1184906059
Name:SCHAEFFER, JONATHAN MOSS (LAC)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:MOSS
Last Name:SCHAEFFER
Suffix:
Gender:M
Credentials:LAC
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Mailing Address - Street 1:8800 GLACIER HWY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8087
Mailing Address - Country:US
Mailing Address - Phone:907-463-3051
Mailing Address - Fax:907-463-3171
Practice Address - Street 1:8800 GLACIER HWY
Practice Address - Street 2:SUITE 111
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8087
Practice Address - Country:US
Practice Address - Phone:907-463-3051
Practice Address - Fax:907-463-3171
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK11171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist