Provider Demographics
NPI:1881759504
Name:JACKSON, CHRISTINA (LAC)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 1ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-3228
Mailing Address - Country:US
Mailing Address - Phone:425-557-9519
Mailing Address - Fax:425-557-0595
Practice Address - Street 1:120 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3228
Practice Address - Country:US
Practice Address - Phone:425-557-9519
Practice Address - Fax:425-557-0595
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000265171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist