Provider Demographics
NPI:1700932282
Name:NIETERS, JOHN ROBERT (LAC DAOM)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ROBERT
Last Name:NIETERS
Suffix:
Gender:M
Credentials:LAC DAOM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2258 SANTA CLARA AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4498
Mailing Address - Country:US
Mailing Address - Phone:510-814-6900
Mailing Address - Fax:510-814-6966
Practice Address - Street 1:2258 SANTA CLARA AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4498
Practice Address - Country:US
Practice Address - Phone:510-814-6900
Practice Address - Fax:510-814-6966
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC6599171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist