Provider Demographics
NPI:1518016419
Name:WEINSTEIN, LARRY IRA (LAC)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:IRA
Last Name:WEINSTEIN
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 1:492 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2834
Mailing Address - Country:US
Mailing Address - Phone:541-344-5882
Mailing Address - Fax:541-344-5882
Practice Address - Street 1:492 W BROADWAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2834
Practice Address - Country:US
Practice Address - Phone:541-344-5882
Practice Address - Fax:541-344-5882
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00074171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist