Healthcare Provider Details

I. General information

NPI: 1124189147
Provider Name (Legal Business Name): JOHN ESKELSON L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 SOUTH ASH STREET
OMAK WA
98841
US

IV. Provider business mailing address

PO BOX 1279
OMAK WA
98841-1279
US

V. Phone/Fax

Practice location:
  • Phone: 509-826-0374
  • Fax: 509-826-7530
Mailing address:
  • Phone: 509-826-0374
  • Fax: 509-826-7530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00000086
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: