Provider Demographics
NPI:1184947327
Name:VANCE, JODY SHONN (LAC)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:SHONN
Last Name:VANCE
Suffix:
Gender:M
Credentials:LAC
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Mailing Address - Street 1:805 SW INDUSTRIAL WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1118
Mailing Address - Country:US
Mailing Address - Phone:541-585-2529
Mailing Address - Fax:541-585-2536
Practice Address - Street 1:1303 NE CUSHING DR
Practice Address - Street 2:SUITE 150
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3887
Practice Address - Country:US
Practice Address - Phone:541-382-7875
Practice Address - Fax:541-382-2181
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2011-12-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXAC01145171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist