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General NPI Number Information
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NPI Number | 1255583498
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Entity Type | Individual
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Provider Name | JEREMY ELI GILSOUL L.AC
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Gender | Male
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 7822 27TH ST W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4111
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Country | US
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Telephone | 253-243-2308
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Fax |
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Provider Business Mailing Address
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Address Line | 5702 N 33RD ST UNIT 26C
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City | TACOMA
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State | WA
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Zip | 98407-2598
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Country | US
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Telephone | 206-669-2355
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 4190-046
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 60487836
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License Number State | WA
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