Provider Demographics
NPI:1366757189
Name:EASTMAN, JULIA A (DOM, CCH, LAC)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:A
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:DOM, CCH, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 N 5TH AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3811
Mailing Address - Country:US
Mailing Address - Phone:602-283-3484
Mailing Address - Fax:602-264-5803
Practice Address - Street 1:3411 N 5TH AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3811
Practice Address - Country:US
Practice Address - Phone:602-283-3484
Practice Address - Fax:602-264-5803
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL778171100000X
AZ614171100000X
FL284175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175L00000XOther Service ProvidersHomeopath