Organization
CRATER LAKE ACUPUNCTURE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER LONG DAOM, DIPL. AC. LAC (OWNER)
(541) 531-2151
Entity
Organization
Contact information
Practice address
3132 STATE ST STE 210, MEDFORD, OR 97504-8691
(541) 414-0503
(541) 414-0504
Mailing address
524 ST AUGUSTINE DR, MEDFORD, OR 97504-2154
(541) 531-2151
(541) 414-0504
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
—
—
Other
Enumeration date
10/13/2022
Last updated
10/13/2022
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