Healthcare Provider Details

I. General information

NPI: 1457651549
Provider Name (Legal Business Name): CHRISTINA MARIE RAUNIG LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2010
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 NW MONROE AVE
CORVALLIS OR
97330-6352
US

IV. Provider business mailing address

5244 SW COMMONS WAY
CORVALLIS OR
97333-1188
US

V. Phone/Fax

Practice location:
  • Phone: 541-754-1717
  • Fax: 541-200-6020
Mailing address:
  • Phone: 541-754-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC150780
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 60140569
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: