Organization
CRATER LAKE ACUPUNCTURE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER LONG D.A.O.M., L.AC. (OWNER OF LLC)
(541) 531-2151
Entity
Organization
Contact information
Practice address
1245 N RIVERSIDE AVE STE 14, MEDFORD, OR 97501-4655
(541) 249-9200
(541) 262-4100
Mailing address
524 ST AUGUSTINE DR, MEDFORD, OR 97504-2154
(541) 531-2151
(541) 262-4100
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
—
—
Other
Enumeration date
07/10/2019
Last updated
07/10/2019
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