Provider Demographics
NPI:1538395306
Name:CROWE, RANDY EUGENE (LAC)
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:EUGENE
Last Name:CROWE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18110 HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:OR
Mailing Address - Zip Code:97378-9519
Mailing Address - Country:US
Mailing Address - Phone:503-831-1422
Mailing Address - Fax:503-831-1422
Practice Address - Street 1:18110 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:OR
Practice Address - Zip Code:97378-9519
Practice Address - Country:US
Practice Address - Phone:503-831-1422
Practice Address - Fax:503-831-1422
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-06
Last Update Date:2009-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00823171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist