Provider Demographics
NPI:1255990982
Name:MATTHEW V. VACCARO LAC INC
Entity type:Organization
Organization Name:MATTHEW V. VACCARO LAC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:VACCARO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:541-459-7410
Mailing Address - Street 1:110 S. STATE ST
Mailing Address - Street 2:
Mailing Address - City:SUTHERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97479
Mailing Address - Country:US
Mailing Address - Phone:541-459-7410
Mailing Address - Fax:541-229-9987
Practice Address - Street 1:110 S. STATE ST
Practice Address - Street 2:
Practice Address - City:SUTHERLIN
Practice Address - State:OR
Practice Address - Zip Code:97479
Practice Address - Country:US
Practice Address - Phone:541-459-7410
Practice Address - Fax:541-229-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty