Provider Demographics
NPI:1538617824
Name:JACKSON, JOCELYN CHIE (LAC)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:CHIE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1961 PRUNERIDGE AVE
Mailing Address - Street 2:B1
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-6575
Mailing Address - Country:US
Mailing Address - Phone:408-758-2881
Mailing Address - Fax:855-781-8279
Practice Address - Street 1:1961 PRUNERIDGE AVE
Practice Address - Street 2:B1
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-6575
Practice Address - Country:US
Practice Address - Phone:408-758-2881
Practice Address - Fax:855-781-8279
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 16969171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist