Matthew V. Vaccaro Lac Inc

Primary specialty

AcupuncturistTaxonomy code 171100000X

Legal business name

MATTHEW V. VACCARO LAC INC

Doing business as

Misty Mountain Acupuncture and Healing Center

Practice address

110 S. State St
Sutherlin, OR 97479

Phone

(541) 459-7410

Fax

(541) 229-9987

NPI assigned

Jun 6, 2019

Last updated

Mar 9, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Matthew Vincent Vaccaro, LA.C

Title

Owner/Acupuncturist

Phone

(541) 459-7410

Specialties & licenses 1

Addresses

Other names 1

• Misty Mountain Acupuncture and Healing Center Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Matt Vincent Vaccaro, LA.C

  • Acupuncturist
  • Sutherlin, OR
  • NPI 1962919415
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583712000000",
    "number": "1255990982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 S. STATE ST",
            "city": "SUTHERLIN",
            "state": "OR",
            "postal_code": "97479",
            "telephone_number": "541-459-7410",
            "fax_number": "541-229-9987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 S. STATE ST",
            "city": "SUTHERLIN",
            "state": "OR",
            "postal_code": "97479",
            "telephone_number": "541-459-7410",
            "fax_number": "541-229-9987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW V. VACCARO LAC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-06",
        "last_updated": "2020-03-09",
        "certification_date": "2020-03-09",
        "status": "A",
        "authorized_official_last_name": "VACCARO",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "VINCENT",
        "authorized_official_title_or_position": "OWNER/ACUPUNCTURIST",
        "authorized_official_telephone_number": "541-459-7410",
        "authorized_official_credential": "LA.C"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Misty Mountain Acupuncture and Healing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Acupuncturist in Sutherlin, OR
• Providers in Sutherlin, OR by specialty
• Acupuncturist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.