Provider Demographics
NPI:1487805644
Name:PREVEC, MICHAEL ANDREW (LAC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANDREW
Last Name:PREVEC
Suffix:
Gender:M
Credentials:LAC
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Mailing Address - Street 1:204 SE FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2821
Mailing Address - Country:US
Mailing Address - Phone:360-975-4879
Mailing Address - Fax:360-695-5390
Practice Address - Street 1:2400 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3229
Practice Address - Country:US
Practice Address - Phone:360-975-4879
Practice Address - Fax:360-695-5390
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2015-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAAC 60251662171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist