MEDICARE: IAN WILKINSON LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization	AC179984	OR

General Provider Information

NPI Number	:	1053857482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IAN WILKINSON LAC

Provider Business Mailing Address
First Line	:	342 NE MORGAN ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-2934
Country	:	US
Telephone Number	:	541-706-1888
Fax Number	:

Provider Business Practice Location Address
First Line	:	4829 NE MARTIN LUTHER KING BLVD
Second Line	:	SUITE 101
City	:	PORTLAND
State	:	OR
Zip	:	97211-3491
Country	:	US
Telephone Number	:	541-706-1888
Fax Number	:

Authorized Official
Title or Position	:	ACUPUNCTURIST
Name	:	IAN JAMES WILKINSON
Credential	:	LAC
Telephone Number	:	541-706-1888

Provider Enumeration Date	:	01/09/2017
Last Update Date	:	01/09/2017

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Directions to “IAN WILKINSON LAC ” Practice Location

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