Healthcare Provider Details

I. General information

NPI: 1275999294
Provider Name (Legal Business Name): DANIELLE SMITH LOCKWOOD N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 SW WESTGATE DR STE 320
PORTLAND OR
97221-2420
US

IV. Provider business mailing address

5440 SW WESTGATE DR STE 320
PORTLAND OR
97221-2447
US

V. Phone/Fax

Practice location:
  • Phone: 503-847-9211
  • Fax:
Mailing address:
  • Phone: 213-509-0764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC175296
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC61161145
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT61140561
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number3066
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: