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1518000140
ANDREA JACKSON
GRESHAM, OR
NPI
1518000140
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
171100000X Acupuncturist
(Licence: OR ac01036)
Enumeration Date
2007-02-14
Last Update Date
2011-07-08
Business Address
-- ANDREA JACKSON LAc
33 NE KELLY AVE
GRESHAM, OR 97030-7539
Phone number: 503-545-2393
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Mailing Address
-- ANDREA JACKSON LAc
2005 SE 159TH PL
VANCOUVER, WA 98683-4406
Phone number: 503-545-2393
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