Provider Demographics
NPI:1538213632
Name:PROCUNIER, STEPHEN KENT (LAC LIC ACUPUNTURIST)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:KENT
Last Name:PROCUNIER
Suffix:
Gender:M
Credentials:LAC LIC ACUPUNTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 CENTRAL AVENUE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420
Mailing Address - Country:US
Mailing Address - Phone:541-267-2142
Mailing Address - Fax:
Practice Address - Street 1:320 CENTRAL AVENUE
Practice Address - Street 2:SUITE 304
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420
Practice Address - Country:US
Practice Address - Phone:541-267-2142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00216171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist