Individual
JACKIE KOEKKOEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSOM, L AC., LMBT
Contact information
Practice address
1105 NEW POINTE BLVD, LELAND, NC 28451-4127
(303) 775-9908
Mailing address
141 MUSCADINE TRL, WALLACE, NC 28466-2365
(303) 775-9908
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
639
NC
Other
Enumeration date
10/05/2012
Last updated
10/05/2012
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