Provider Demographics
NPI:1598969370
Name:STONE, MARK K (LAC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:K
Last Name:STONE
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 1:1525 12TH ST
Mailing Address - Street 2:STE. 30
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-9497
Mailing Address - Country:US
Mailing Address - Phone:541-991-2058
Mailing Address - Fax:
Practice Address - Street 1:1525 12TH ST
Practice Address - Street 2:STE. 30
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-9497
Practice Address - Country:US
Practice Address - Phone:541-991-2058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00510171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist