Healthcare Provider Details

I. General information

NPI: 1487285086
Provider Name (Legal Business Name): OCEAN KI ACUPUNCTURE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2020
Last Update Date: 02/01/2020
Certification Date: 02/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136A W MAIN RD
MIDDLETOWN RI
02842-4937
US

IV. Provider business mailing address

136A W MAIN RD
MIDDLETOWN RI
02842-4937
US

V. Phone/Fax

Practice location:
  • Phone: 401-862-4894
  • Fax:
Mailing address:
  • Phone: 401-862-4894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER S JACKSON
Title or Position: ACUPUNCTURIST/OWNER
Credential: DAOM
Phone: 401-862-4894