Healthcare Provider Details

I. General information

NPI: 1689977647
Provider Name (Legal Business Name): KALINNA ALDERMAN LMT, CA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 PACIFIC AVE # P
BROOKINGS OR
97415-0241
US

IV. Provider business mailing address

206 WILENE CT
ROSEBURG OR
97471-9687
US

V. Phone/Fax

Practice location:
  • Phone: 458-257-7918
  • Fax:
Mailing address:
  • Phone: 458-257-7918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number17212
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number17212
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: