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1255583498 NPI number — JEREMY ELI GILSOUL L.AC

NPI Number: 1255583498
Health Care Provider/Practitioner: JEREMY ELI GILSOUL L.AC

Information about “1255583498” NPI (JEREMY ELI GILSOUL L.AC) exists in 1255583498 in HTML format HTML  |  1255583498 in plain Text format TXT  |  1255583498 in PDF (Portable Document Format) PDF  |  1255583498 in an XML format XML  formats.

NPI Number : 1255583498 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255583498",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GILSOUL",
    "FirstName": "JEREMY",
    "MiddleName": "ELI",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "L.AC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5702 N 33RD ST UNIT 26C",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TACOMA",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98407-2598",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "206-669-2355",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "7822 27TH ST W",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "UNIVERSITY PLACE",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98466-4111",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "253-243-2308",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/21/2008",
    "LastUpdateDate": "01/12/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "174400000X",
          "TaxonomyName": "Specialist",
          "LicenseNumber": "4190-046",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "171100000X",
          "TaxonomyName": "Acupuncturist",
          "LicenseNumber": "AC 60487836",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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