Provider Demographics
NPI:1760298681
Name:BULLOCH, MEGAN JANE (LAC)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:JANE
Last Name:BULLOCH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38041 SE RICKERT RD
Mailing Address - Street 2:
Mailing Address - City:CORBETT
Mailing Address - State:OR
Mailing Address - Zip Code:97019-9715
Mailing Address - Country:US
Mailing Address - Phone:775-790-7606
Mailing Address - Fax:
Practice Address - Street 1:38041 SE RICKERT RD
Practice Address - Street 2:
Practice Address - City:CORBETT
Practice Address - State:OR
Practice Address - Zip Code:97019-9715
Practice Address - Country:US
Practice Address - Phone:775-790-7606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC223288171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist