Provider Demographics
NPI:1679113419
Name:CONSTANTINE, JAMES MICHAEL (MSOM, LAC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:CONSTANTINE
Suffix:
Gender:M
Credentials:MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 CAT AVE APT C
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-7683
Mailing Address - Country:US
Mailing Address - Phone:406-425-1773
Mailing Address - Fax:
Practice Address - Street 1:440 CAT AVE APT C
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-7683
Practice Address - Country:US
Practice Address - Phone:406-425-1773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT78660171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist