Healthcare Provider Details

I. General information

NPI: 1275694895
Provider Name (Legal Business Name): JOHN DONALD LAC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2843 HOWARD RD
LANGLEY WA
98260-9731
US

IV. Provider business mailing address

PO BOX 1236
LANGLEY WA
98260-1236
US

V. Phone/Fax

Practice location:
  • Phone: 360-331-7331
  • Fax: 360-331-7343
Mailing address:
  • Phone: 360-331-7331
  • Fax: 360-331-7343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number455
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: