Provider Demographics
NPI:1962600932
Name:COFFMAN, ALAN BRUCE (LAC)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:BRUCE
Last Name:COFFMAN
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 1:1434 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-2406
Mailing Address - Country:US
Mailing Address - Phone:541-752-1228
Mailing Address - Fax:
Practice Address - Street 1:552 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4439
Practice Address - Country:US
Practice Address - Phone:541-602-2229
Practice Address - Fax:541-752-1228
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00383171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist