Provider Demographics
NPI:1740312404
Name:VAN VOAST, JORDAN H (LAC)
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:H
Last Name:VAN VOAST
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2524 16TH AVE S
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-5104
Mailing Address - Country:US
Mailing Address - Phone:206-860-5009
Mailing Address - Fax:
Practice Address - Street 1:2524 16TH AVE S
Practice Address - Street 2:SUITE 301
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-5104
Practice Address - Country:US
Practice Address - Phone:206-860-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000432171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist