Andrea Jackson, LAC

NPI #1518000140 in Gresham, Oregon

Provider Information

NPI Number: 1518000140
Entity Type: Individual
Name: Andrea Jackson, LAC
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Acupuncturist
Credential: LAC
Enumeration Date: Feb 14, 2007
Last Updated: Jul 8, 2011

Practice Location

Address: 33 NE KELLY AVE
City: Gresham
State: Oregon
ZIP Code: 97030-7539
Phone: (503) 545-2393

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Acupuncturist	171100000X	Primary

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