NPI 1184022659

Ida Olivia Jackson, LACLMT

Practitioner Acupuncturist Kirkwood, MO

Practice location

Address: 103 N Taylor Ave Suite B, Kirkwood, MO 63122-4360
Phone: (314) 623-2302

Registered specialties

Acupuncturist Primary

Other Service Providers Taxonomy 171100000X Licence 2013032932 (MO)

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Registry record

NPI: 1184022659
Entity type: Individual
Sex (as registered): Female
NPI issued: 15 Dec 2014
Record last updated: 15 Dec 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.