Provider Demographics
NPI:1982812525
Name:BERGER, LISA LYNN (LAC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:LYNN
Last Name:BERGER
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 1:1657 HUBBARD LN
Mailing Address - Street 2:SHEN MING ACUPUNCTURE
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-6312
Mailing Address - Country:US
Mailing Address - Phone:541-955-8090
Mailing Address - Fax:541-955-8090
Practice Address - Street 1:1657 HUBBARD LN
Practice Address - Street 2:SHEN MING ACUPUNCTURE
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-6312
Practice Address - Country:US
Practice Address - Phone:541-955-8090
Practice Address - Fax:541-955-8090
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00309171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist