Brett Leigh Halderman, LAC
Individual provider Active NPI Acupuncturist · Enterprise, OR
NPI 1992392419 · NPPES record last updated Jan 14, 2021
Key facts
- NPI
- 1992392419
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Acupuncturist 171100000X
- License
- AC168387 (OR)
- Practice address
- 507 S River St
Enterprise, OR 97828-1601 - Phone
- (541) 426-4502
- NPI assigned
- Dec 30, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AC168387 | OR | MD | Acupuncturist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Winding Waters Medical Clinic | Past |
Accepting new patients | |
| Winding Waters Medical Clinic | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | AC168387 | OR | Yes |
Addresses
Primary practice location
507 S River St
Enterprise, OR 97828-1601
Mailing address
603 Medical Pkwy
Enterprise, OR 97828-5124
Phone (541) 426-4502
Other practice location 1
603 Medical Pkwy
Enterprise, OR 97828-5124
Phone (541) 426-4502
Other providers in Enterprise, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 14, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.