Provider Demographics
NPI:1861939647
Name:HARRELSON, JOSHUA (LAC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:HARRELSON
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 1:2409 L ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-7270
Mailing Address - Country:US
Mailing Address - Phone:916-918-5568
Mailing Address - Fax:
Practice Address - Street 1:2409 L ST STE 103
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7270
Practice Address - Country:US
Practice Address - Phone:916-918-5568
Practice Address - Fax:916-624-9946
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 16041171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist