Provider Demographics
NPI:1528282613
Name:JAHN, RICK R JR (DOM)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:R
Last Name:JAHN
Suffix:JR
Gender:M
Credentials:DOM
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Mailing Address - Street 1:1150 S COLONY WAY
Mailing Address - Street 2:SUITE 3 #145
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645
Mailing Address - Country:US
Mailing Address - Phone:904-419-3558
Mailing Address - Fax:
Practice Address - Street 1:1734 PROSPECT DRIVE
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645
Practice Address - Country:US
Practice Address - Phone:907-746-7842
Practice Address - Fax:907-745-7883
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3073171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist