Provider Demographics
NPI:1538227137
Name:MCKOWN, JACOB C (LMP)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:C
Last Name:MCKOWN
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
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Mailing Address - Street 1:7352 27TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5933
Mailing Address - Country:US
Mailing Address - Phone:206-784-0482
Mailing Address - Fax:425-424-2371
Practice Address - Street 1:18920 BOTHELL WAY NE
Practice Address - Street 2:SUITE 204
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-1981
Practice Address - Country:US
Practice Address - Phone:425-424-3730
Practice Address - Fax:425-424-2371
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMA11841225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4853MCOtherBLUE SHIELD