Healthcare Provider Details

I. General information

NPI: 1336808302
Provider Name (Legal Business Name): MERIDIAN ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 S OLD PACIFIC HWY STE 100
MYRTLE CREEK OR
97457-8785
US

IV. Provider business mailing address

PO BOX 127
DAYS CREEK OR
97429-0127
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: CARRIE LOVEMARK
Title or Position: OWNER
Credential: L.AC
Phone: 541-517-9869