Healthcare Provider Details

I. General information

NPI: 1982205332
Provider Name (Legal Business Name): MICHELLE JEAN CHAMPION L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE JEAN BUMMINS L.AC.

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 BEVINS CT
LAKEPORT CA
95453-9754
US

IV. Provider business mailing address

PO BOX 1950
LAKEPORT CA
95453-1950
US

V. Phone/Fax

Practice location:
  • Phone: 707-263-8383
  • Fax: 707-263-5019
Mailing address:
  • Phone: 707-263-8383
  • Fax: 707-263-5019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number12768
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: