Provider Demographics
NPI:1487950432
Name:GERBER, CELISHA RUNNE (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:CELISHA
Middle Name:RUNNE
Last Name:GERBER
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 E MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7115
Mailing Address - Country:US
Mailing Address - Phone:407-257-3557
Mailing Address - Fax:
Practice Address - Street 1:836 E MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7115
Practice Address - Country:US
Practice Address - Phone:407-257-3557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60162000175F00000X
TN247171100000X
OR2088175F00000X
ORAC 171363171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist