Provider Demographics
NPI:1255371084
Name:MIXER, MATTHEW RICHARD (LAC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RICHARD
Last Name:MIXER
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 1:260 E 15TH AVE
Mailing Address - Street 2:B
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4177
Mailing Address - Country:US
Mailing Address - Phone:541-345-5972
Mailing Address - Fax:
Practice Address - Street 1:260 E 15TH AVE
Practice Address - Street 2:B
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4177
Practice Address - Country:US
Practice Address - Phone:541-345-5972
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00341171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist