Provider Demographics
NPI:1053475152
Name:AMMEN, JONATHAN B (LIC AC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:B
Last Name:AMMEN
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 BAKER BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MA
Mailing Address - Zip Code:01773-3105
Mailing Address - Country:US
Mailing Address - Phone:781-641-6313
Mailing Address - Fax:
Practice Address - Street 1:ACUPUNCTURE
Practice Address - Street 2:1365 MASSACHUSETTS AVE
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474
Practice Address - Country:US
Practice Address - Phone:781-641-6313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA139171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist