Provider Demographics
NPI:1003602830
Name:HANDLOSER, MONIQUE (LAC)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:HANDLOSER
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 29TH PL
Mailing Address - Street 2:
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-9369
Mailing Address - Country:US
Mailing Address - Phone:541-609-0087
Mailing Address - Fax:
Practice Address - Street 1:107 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4715
Practice Address - Country:US
Practice Address - Phone:541-602-8172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC223813171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist