Provider Demographics
NPI:1457682783
Name:JENKINS, STERLING CHRISTOPHER MOSES (LAC)
Entity Type:Individual
Prefix:
First Name:STERLING
Middle Name:CHRISTOPHER MOSES
Last Name:JENKINS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:MOSES
Other - Middle Name:
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7724 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-4004
Mailing Address - Country:US
Mailing Address - Phone:206-226-5533
Mailing Address - Fax:
Practice Address - Street 1:7724 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4004
Practice Address - Country:US
Practice Address - Phone:206-226-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60114446171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist