Healthcare Provider Details

I. General information

NPI: 1316322597
Provider Name (Legal Business Name): CARRIE LOVEMARK L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 S. OLD PACIFIC HWY, SUITE #100
MYRTLE CREEK OR
97457
US

IV. Provider business mailing address

PO BOX 127
DAYS CREEK OR
97429
US

V. Phone/Fax

Practice location:
  • Phone: 541-860-1515
  • Fax: 541-543-2220
Mailing address:
  • Phone: 541-517-9869
  • Fax: 541-543-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number172295
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC172295
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: