Provider Demographics
NPI:1760751044
Name:PREWITT, GABRIEL STEVEN (LAC)
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:STEVEN
Last Name:PREWITT
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3847 MEADOWLAWN LOOP SE APT 6
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-5358
Mailing Address - Country:US
Mailing Address - Phone:503-730-4203
Mailing Address - Fax:
Practice Address - Street 1:10001 SE SUNNYSIDE RD STE 204
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9704
Practice Address - Country:US
Practice Address - Phone:503-730-4203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC156435171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist