Jacquelyn R Riddick, LAC.

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

005208-1 Issued in NY

Practice address

394 Hasbrouck Ave.
Kingston, NY 12401

Phone

(845) 750-4896

NPI assigned

Apr 14, 2014

Last updated

Sep 13, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Ms. Jacquelyn R McDonald Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eagle Peak Wellness, Inc.

  dba Eagle Peak Acupuncture

  • Clinic/Center
  • Kingston, NY
  • NPI 1396411690
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694563200000",
    "number": "1184043572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "394 HASBROUCK AVE #2C",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "12401",
            "telephone_number": "845-750-4896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "394 HASBROUCK AVE.",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "12401",
            "telephone_number": "845-750-4896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDDICK",
        "first_name": "JACQUELYN",
        "middle_name": "R",
        "name_prefix": "Ms.",
        "credential": "LAC.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-14",
        "last_updated": "2023-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NY",
            "license": "25 005208",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "NY",
            "license": "019298-1",
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": "NY",
            "license": "005208-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELYN",
            "last_name": "MCDONALD",
            "middle_name": "R",
            "prefix": "MS.",
            "credential": "LAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Richard W. Moscowitz, M.D., P.a., P.C.
• Jennifer A Richards, ORTON-GILLINGHAM
• Keenan Robert Richards, M.D.
• Patricia Riche, COTA/L
• Stephanie Richers, LCSW
• Christina Rider, LPN
• Mary E Rider, RN
• Megan Riebesell
• Rite Aid of New York Inc (Rite Aid Pharmacy 01090)
• Diane Ritters

• Acupuncturist in Kingston, NY
• Providers in Kingston, NY by specialty
• Acupuncturist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.