Healthcare Provider Details

I. General information

NPI: 1720228133
Provider Name (Legal Business Name): ZACHARY BANNON CORBETT L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E BROADWAY SUITE #312
EUGENE OR
97401-3143
US

IV. Provider business mailing address

132 E BROADWAY SUITE #312
EUGENE OR
97401-3143
US

V. Phone/Fax

Practice location:
  • Phone: 541-228-4822
  • Fax: 541-686-9424
Mailing address:
  • Phone: 541-228-4822
  • Fax: 541-686-9424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 8372
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 822
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: