Provider Demographics
NPI:1659690329
Name:MALLORY, ERIC P (MD, ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:P
Last Name:MALLORY
Suffix:
Gender:M
Credentials:MD, ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 NW MT WASHINGTON DR STE 104
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-1574
Mailing Address - Country:US
Mailing Address - Phone:541-639-3494
Mailing Address - Fax:541-306-3237
Practice Address - Street 1:745 NW MT WASHINTON DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703
Practice Address - Country:US
Practice Address - Phone:541-639-3494
Practice Address - Fax:541-306-3237
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC154596171100000X
OR3079175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath