Provider Demographics
NPI:1821432659
Name:TRUHAN, MATTHEW (LAC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:TRUHAN
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 1:61138 BUCKSHOT PL
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2992
Mailing Address - Country:US
Mailing Address - Phone:619-602-9815
Mailing Address - Fax:
Practice Address - Street 1:1345 NW WALL ST
Practice Address - Street 2:#202
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-1972
Practice Address - Country:US
Practice Address - Phone:541-318-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15357171100000X
ORAC168258171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist