Provider Demographics
NPI:1396990982
Name:HARBIN, ADDIE R (LAC, DACM, MACOM)
Entity type:Individual
Prefix:DR
First Name:ADDIE
Middle Name:R
Last Name:HARBIN
Suffix:
Gender:F
Credentials:LAC, DACM, MACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1753 S 14TH ST W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-4923
Mailing Address - Country:US
Mailing Address - Phone:503-853-2517
Mailing Address - Fax:
Practice Address - Street 1:1753 S 14TH ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4923
Practice Address - Country:US
Practice Address - Phone:503-853-2517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01216171100000X
MTMED-ACU-LIC-60748171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist