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Individual

JACKIE EARLENE PRIMOS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMT

Contact information

Practice address
7895 BROADWAY STE D, MERRILLVILLE, IN 46410-5529
(219) 440-6612
Mailing address
1952 W 2ND AVE, GARY, IN 46404-1108
(219) 794-4626

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT22308074
IN

Other

Enumeration date
01/25/2024
Last updated
01/25/2024
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