Provider Demographics
NPI:1407489503
Name:JAQUITH, ANNA CHRISTINE (LAC, LMT)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:CHRISTINE
Last Name:JAQUITH
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 494
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-0494
Mailing Address - Country:US
Mailing Address - Phone:715-798-3330
Mailing Address - Fax:
Practice Address - Street 1:15657 COUNTY HIGHWAY B
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-2680
Practice Address - Country:US
Practice Address - Phone:715-798-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1044-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty