Provider Demographics
NPI:1316153448
Name:MIODUSKI, DAVID GEORGE (L AC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:GEORGE
Last Name:MIODUSKI
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5008 159TH CT NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5267
Mailing Address - Country:US
Mailing Address - Phone:206-226-3269
Mailing Address - Fax:425-702-0466
Practice Address - Street 1:10627 NE 68TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7054
Practice Address - Country:US
Practice Address - Phone:206-226-3269
Practice Address - Fax:425-702-0466
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000621171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist