Provider Demographics
NPI:1699214783
Name:MYERS, MCKENZIE RHEA (ND, LAC)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:RHEA
Last Name:MYERS
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83377 SPRUCE LN
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-8322
Mailing Address - Country:US
Mailing Address - Phone:405-630-9773
Mailing Address - Fax:
Practice Address - Street 1:1845 OR 126
Practice Address - Street 2:UNIT H
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439
Practice Address - Country:US
Practice Address - Phone:541-991-3917
Practice Address - Fax:541-991-3918
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR198662171100000X
WA60712952171100000X
WA60724044175F00000X
OR4386175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist