Provider Demographics
NPI:1144496159
Name:FUSELIER, DAVID JUDE (LAC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JUDE
Last Name:FUSELIER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 W OLYMPIC PL
Mailing Address - Street 2:#209
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-3647
Mailing Address - Country:US
Mailing Address - Phone:206-817-4504
Mailing Address - Fax:
Practice Address - Street 1:419 QUEEN ANNE AVE N
Practice Address - Street 2:STE 103
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4518
Practice Address - Country:US
Practice Address - Phone:206-817-4504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000222171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist