Provider Demographics
NPI:1710213202
Name:MCINTYRE, CAROL (ND, LAC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:MCINTYRE
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 1:1004 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:VERNONIA
Mailing Address - State:OR
Mailing Address - Zip Code:97064-1144
Mailing Address - Country:US
Mailing Address - Phone:503-481-4096
Mailing Address - Fax:
Practice Address - Street 1:786 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:VERNONIA
Practice Address - State:OR
Practice Address - Zip Code:97064-1144
Practice Address - Country:US
Practice Address - Phone:503-481-4096
Practice Address - Fax:503-429-7209
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR140949171100000X
OR1726175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist