MEDICARE: MR. OWEN DAVID JURLING LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC00926	OR

General Provider Information

NPI Number	:	1790907798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. OWEN DAVID JURLING LAC

Provider Business Mailing Address
First Line	:	675 N. 5TH
Second Line	:
City	:	JACKSONVILLE
State	:	OR
Zip	:	97530-9659
Country	:	US
Telephone Number	:	541-899-2055
Fax Number	:	541-899-2266

Provider Business Practice Location Address
First Line	:	675 N. 5TH
Second Line	:
City	:	JACKSONVILLE
State	:	OR
Zip	:	97530-9659
Country	:	US
Telephone Number	:	541-899-2055
Fax Number	:	541-899-2266

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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