Provider Demographics
NPI:1154611358
Name:ON, DAT (LAC)
Entity type:Individual
Prefix:
First Name:DAT
Middle Name:
Last Name:ON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5904 N EL DORADO ST
Mailing Address - Street 2:STE A
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-4467
Mailing Address - Country:US
Mailing Address - Phone:209-898-7525
Mailing Address - Fax:209-898-7525
Practice Address - Street 1:5904 N EL DORADO ST
Practice Address - Street 2:STE A
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-4467
Practice Address - Country:US
Practice Address - Phone:209-898-7525
Practice Address - Fax:209-898-7525
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-09
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC14184171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist