Provider Demographics
NPI:1356199665
Name:SMITH, JAMIE LYNN (DCM, LAC, NBC-HWC)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:
Credentials:DCM, LAC, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23276 SKANEE RD
Mailing Address - Street 2:
Mailing Address - City:SKANEE
Mailing Address - State:MI
Mailing Address - Zip Code:49962
Mailing Address - Country:US
Mailing Address - Phone:906-231-0369
Mailing Address - Fax:833-740-3401
Practice Address - Street 1:902 RAZORBACK DR STE 5
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-2802
Practice Address - Country:US
Practice Address - Phone:906-301-0046
Practice Address - Fax:833-470-3401
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIA-39220250171400000X
MI5402000316171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturist
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty