Provider Demographics
NPI:1710312186
Name:BONNIE ARENT LORENZ, INC.
Entity Type:Organization
Organization Name:BONNIE ARENT LORENZ, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:ARENT
Authorized Official - Last Name:LORENZ
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:541-758-9334
Mailing Address - Street 1:712 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6415
Mailing Address - Country:US
Mailing Address - Phone:541-758-9334
Mailing Address - Fax:541-758-1334
Practice Address - Street 1:712 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6415
Practice Address - Country:US
Practice Address - Phone:541-758-9334
Practice Address - Fax:541-758-1334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC000235171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150606Medicaid