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General NPI Number Information
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NPI Number | 1174845788
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Entity Type | Individual
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Provider Name | JASON MICHAEL LANDRY L.AC.
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Gender | Male
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Dates
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Enumeration Date | 02/23/2010
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Last Update Date | 02/23/2010
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Provider Practice Location Address
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Address Line | 3417 FREMONT AVE N STE 305
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City | SEATTLE
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State | WA
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Zip | 98103-3411
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Country | US
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Telephone | 206-621-5181
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Fax |
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Provider Business Mailing Address
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Address Line | 2530 SW 119TH PL
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City | BURIEN
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State | WA
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Zip | 98146-2513
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Country | US
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Telephone | 206-612-5181
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 60135383
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License Number State | WA
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