Healthcare Provider Details

I. General information

NPI: 1255583498
Provider Name (Legal Business Name): JEREMY ELI GILSOUL L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 01/12/2023
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7822 27TH ST W
UNIVERSITY PLACE WA
98466-4111
US

IV. Provider business mailing address

5702 N 33RD ST UNIT 26C
TACOMA WA
98407-2598
US

V. Phone/Fax

Practice location:
  • Phone: 253-243-2308
  • Fax:
Mailing address:
  • Phone: 206-669-2355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 60487836
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number4190-046
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: