Healthcare Provider Details

I. General information

NPI: 1851591762
Provider Name (Legal Business Name): ONDRIA LOUISE HOLUB BS, M.AC.O.M, L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 NW GRANT AVE
CORVALLIS OR
97330-4366
US

IV. Provider business mailing address

2005 NW GRANT AVE
CORVALLIS OR
97330-4366
US

V. Phone/Fax

Practice location:
  • Phone: 541-714-3200
  • Fax: 541-638-3275
Mailing address:
  • Phone: 541-714-3200
  • Fax: 541-638-3275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC01108
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: