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General NPI Number Information
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NPI Number | 1609683481
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Entity Type | Organization
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Legal Business Name | JAGUAR INTEGRATIVE LLC
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 10560 MAIN ST STE 403
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City | FAIRFAX
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State | VA
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Zip | 22030-7174
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Country | US
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Telephone | 703-594-9157
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Fax |
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Provider Business Mailing Address
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Address Line | 10560 MAIN ST STE 403
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City | FAIRFAX
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State | VA
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Zip | 22030-7174
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/DOCTOR OF ACUPUNCTURE
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Name | DR. DION MARCELLUS BLACKMON
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Credential | DACHM, LAC
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Telephone | 703-594-9157
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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 |
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License Number State |
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