MEDICARE: DEBORAH J LANG LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC570	OR

General Provider Information

NPI Number	:	1134281868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH J LANG LAC

Provider Business Mailing Address
First Line	:	1051 NE 6TH ST
Second Line	:	STE 1B
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1190
Country	:	US
Telephone Number	:	541-956-9595
Fax Number	:	541-956-9594

Provider Business Practice Location Address
First Line	:	1051 NE 6TH ST
Second Line	:	STE 1B
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1190
Country	:	US
Telephone Number	:	541-956-9595
Fax Number	:	541-956-9594

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2006
Last Update Date	:	07/08/2007

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