Provider Demographics
NPI:1790907798
Name:JURLING, OWEN DAVID (LAC)
Entity Type:Individual
Prefix:MR
First Name:OWEN
Middle Name:DAVID
Last Name:JURLING
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:675 N. 5TH
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-9659
Mailing Address - Country:US
Mailing Address - Phone:541-899-2055
Mailing Address - Fax:541-899-2266
Practice Address - Street 1:675 N. 5TH
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530-9659
Practice Address - Country:US
Practice Address - Phone:541-899-2055
Practice Address - Fax:541-899-2266
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00926171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist