Provider Demographics
NPI:1720228133
Name:CORBETT, ZACHARY BANNON (LAC)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:BANNON
Last Name:CORBETT
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 1:132 E BROADWAY
Mailing Address - Street 2:SUITE #312
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3143
Mailing Address - Country:US
Mailing Address - Phone:541-228-4822
Mailing Address - Fax:541-686-9424
Practice Address - Street 1:132 E BROADWAY
Practice Address - Street 2:SUITE #312
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3143
Practice Address - Country:US
Practice Address - Phone:541-228-4822
Practice Address - Fax:541-686-9424
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 8372171100000X
ORAC 822171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist