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General NPI Number Information
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NPI Number | 1720537525
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Entity Type | Organization
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Legal Business Name | JOURNEY INTEGRATIVE MEDICINE
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 2400 BROADWAY ST
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City | VANCOUVER
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State | WA
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Zip | 98663-3229
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Country | US
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Telephone | 360-865-5556
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 BROADWAY ST
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City | VANCOUVER
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State | WA
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Zip | 98663-3229
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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
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Name | JESSICA MARIE CAMPBELL
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Credential | LAC
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Telephone | 360-865-5556
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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 | AC60688469
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License Number State | WA
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