Provider Demographics
NPI:1861531543
Name:BARKSTROM, JEFFREY (LAC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:BARKSTROM
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 1:500 PINE ST
Mailing Address - Street 2:MEDICAL ARTS BUILDING
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-5384
Mailing Address - Country:US
Mailing Address - Phone:716-665-5015
Mailing Address - Fax:
Practice Address - Street 1:500 PINE ST
Practice Address - Street 2:MEDICAL ARTS BUILDING
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5384
Practice Address - Country:US
Practice Address - Phone:716-665-5015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3252171100000X
PAKO000595171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist