MEDICARE: ADAM S. JACKSON L.AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC00001996	WA

General Provider Information

NPI Number	:	1033257662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM S. JACKSON L.AC.

Provider Business Mailing Address
First Line	:	5800 SOUNDVIEW DR STE C101
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-2077
Country	:	US
Telephone Number	:	253-858-9609
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 SOUNDVIEW DR STE C101
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-2077
Country	:	US
Telephone Number	:	253-858-9609
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2007
Last Update Date	:	07/08/2007

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Directions to “ ADAM S. JACKSON L.AC.” Practice Location

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