Provider Demographics
NPI:1609683481
Name:JAGUAR INTEGRATIVE LLC
Entity type:Organization
Organization Name:JAGUAR INTEGRATIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR OF ACUPUNCTURE
Authorized Official - Prefix:DR
Authorized Official - First Name:DION
Authorized Official - Middle Name:MARCELLUS
Authorized Official - Last Name:BLACKMON
Authorized Official - Suffix:
Authorized Official - Credentials:DACHM, LAC
Authorized Official - Phone:703-594-9157
Mailing Address - Street 1:10560 MAIN ST STE 403
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7174
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10560 MAIN ST STE 403
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7174
Practice Address - Country:US
Practice Address - Phone:703-594-9157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty