Provider Demographics
NPI:1780879338
Name:CARSON-CROPP, DEBRA MARIE (LAC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:MARIE
Last Name:CARSON-CROPP
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SW 2ND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-4156
Mailing Address - Country:US
Mailing Address - Phone:503-266-7999
Mailing Address - Fax:
Practice Address - Street 1:130 SW 2ND AVE STE 101
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-4156
Practice Address - Country:US
Practice Address - Phone:503-266-7999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00930171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist