Provider Demographics
NPI:1306388095
Name:DREISBACH, TINA (PHD, ND LAC)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:DREISBACH
Suffix:
Gender:F
Credentials:PHD, ND LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4437
Mailing Address - Country:US
Mailing Address - Phone:541-602-0260
Mailing Address - Fax:
Practice Address - Street 1:650 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4437
Practice Address - Country:US
Practice Address - Phone:541-602-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC189838171100000X
WAAC60805981171100000X
WANT 60703113175F00000X
OR4166175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist