Provider Demographics
NPI:1992759773
Name:VENZKE, LIANE L (DAOM, LAC)
Entity type:Individual
Prefix:
First Name:LIANE
Middle Name:L
Last Name:VENZKE
Suffix:
Gender:F
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 BIEHN ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1761
Mailing Address - Country:US
Mailing Address - Phone:541-882-4612
Mailing Address - Fax:541-273-2908
Practice Address - Street 1:2345 BIEHN ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1761
Practice Address - Country:US
Practice Address - Phone:541-882-4612
Practice Address - Fax:541-273-2908
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00342171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist