Provider Demographics
NPI:1013307024
Name:BEWICK, JUBAL J (EAMP, MSAOM)
Entity type:Individual
Prefix:MR
First Name:JUBAL
Middle Name:J
Last Name:BEWICK
Suffix:
Gender:M
Credentials:EAMP, MSAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 MELROSE ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-1581
Mailing Address - Country:US
Mailing Address - Phone:509-876-4597
Mailing Address - Fax:509-876-4599
Practice Address - Street 1:2200 MELROSE ST
Practice Address - Street 2:SUITE 9
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-1581
Practice Address - Country:US
Practice Address - Phone:509-876-4597
Practice Address - Fax:509-876-4599
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60511065171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist