Healthcare Provider Details

I. General information

NPI: 1588930986
Provider Name (Legal Business Name): ERIC IKAIKA AKI L.M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 NE HOGAN DR
GRESHAM OR
97030-5814
US

IV. Provider business mailing address

1615 SW MORRISON ST APT 108
PORTLAND OR
97205-1850
US

V. Phone/Fax

Practice location:
  • Phone: 808-651-6692
  • Fax:
Mailing address:
  • Phone: 808-651-6692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18713
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: