=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467685768
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTINA JACKSON L.AC. AND ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2009
-----------------------------------------------------
Last Update Date | 08/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 711 ST HELENS AVE STE 103B
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98402-3736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-780-2006
-----------------------------------------------------
Fax | 253-356-7457
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 711 ST HELENS AVE STE 103B
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98402-3736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-780-2006
-----------------------------------------------------
Fax | 253-356-7457
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER
-----------------------------------------------------
Name | CHRISTINA M JACKSON
-----------------------------------------------------
Credential | DAHM, LAC
-----------------------------------------------------
Telephone | 253-780-2006
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC00000265
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------