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General NPI Number Information
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NPI Number | 1649636788
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Entity Type | Individual
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Provider Name | TARA ANDERSON L.AC., FABORM
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Gender | Female
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Dates
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Enumeration Date | 01/05/2016
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 235 W D ST
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City | JACKSONVILLE
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State | OR
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Zip | 97530-0038
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Country | US
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Telephone | 541-838-0980
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 895
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City | JACKSONVILLE
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State | OR
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Zip | 97530-0895
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Country | US
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Telephone | 541-838-0980
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 16394
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 201642
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License Number State | OR
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