Healthcare Provider Details

I. General information

NPI: 1245630045
Provider Name (Legal Business Name): JENNIFER HENDERSON DAOM, L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 CIVIC DR STE 111
WALNUT CREEK CA
94596-8231
US

IV. Provider business mailing address

1111 CIVIC DR STE 111
WALNUT CREEK CA
94596-8231
US

V. Phone/Fax

Practice location:
  • Phone: 925-457-2921
  • Fax:
Mailing address:
  • Phone: 925-457-2921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 14663
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: