# JAMIE SLAGEL LAC LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Eagle Cap Wellness
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013504208
- **Authorized official:** DR. JAMIE KIMBALL DACM (OWNER)
- **Authorized official phone:** (541) 398-8318

## Contact information

- **Practice address:** 616 W NORTH ST, ENTERPRISE, OR 97828-1427
- **Practice address phone:** (541) 398-8318
- **Practice address fax:** (541) 960-3904
- **Mailing address:** 616 W NORTH ST, ENTERPRISE, OR 97828-1427
- **Mailing address phone:** (541) 398-8318
- **Mailing address fax:** (541) 960-3904

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 12/22/2020
- **Last updated:** 12/22/2020