Provider Demographics
NPI:1649546292
Name:CHINN, JACOB MICHAEL (LAC, MSTCM)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:MICHAEL
Last Name:CHINN
Suffix:
Gender:M
Credentials:LAC, MSTCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1756 LACASSIE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-7098
Mailing Address - Country:US
Mailing Address - Phone:925-939-0300
Mailing Address - Fax:
Practice Address - Street 1:1756 LACASSIE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-7098
Practice Address - Country:US
Practice Address - Phone:925-939-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13669171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist