Healthcare Provider Details

I. General information

NPI: 1497299259
Provider Name (Legal Business Name): MARACUPUNCTURE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2016
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 SW CENTURY DR STE 120
BEND OR
97702-1167
US

IV. Provider business mailing address

497 SW CENTURY DR STE 120
BEND OR
97702-1167
US

V. Phone/Fax

Practice location:
  • Phone: 541-280-4882
  • Fax:
Mailing address:
  • Phone: 541-280-4882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARA S KEVAN
Title or Position: OWNER
Credential: LAC
Phone: 541-280-4882