Provider Demographics
NPI:1215173067
Name:LEIBOWITZ, JASON KIM (LAC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:KIM
Last Name:LEIBOWITZ
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:LEIBOWITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:68 ASHEVILLE HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-5118
Mailing Address - Country:US
Mailing Address - Phone:828-508-1941
Mailing Address - Fax:828-586-0169
Practice Address - Street 1:68 ASHEVILLE HWY
Practice Address - Street 2:SUITE B
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5118
Practice Address - Country:US
Practice Address - Phone:828-508-1941
Practice Address - Fax:828-586-0169
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC521171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist