Healthcare Provider Details

I. General information

NPI: 1841413812
Provider Name (Legal Business Name): KIP MARILYN HARD DC, L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 01/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 NE 28TH AVE
PORTLAND OR
97232-3150
US

IV. Provider business mailing address

316 NE 28TH AVE
PORTLAND OR
97232-3150
US

V. Phone/Fax

Practice location:
  • Phone: 503-230-0812
  • Fax:
Mailing address:
  • Phone: 503-230-0812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1670
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00351
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: