Healthcare Provider Details

I. General information

NPI: 1477511731
Provider Name (Legal Business Name): LOWELL MARK CHODOSH ND, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2332 NW IRVING ST
PORTLAND OR
97210-3225
US

IV. Provider business mailing address

7633 SW ALOMA WAY APT 5
PORTLAND OR
97223-7936
US

V. Phone/Fax

Practice location:
  • Phone: 503-222-1865
  • Fax:
Mailing address:
  • Phone: 503-816-9843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00314
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number0770
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: