Healthcare Provider Details

I. General information

NPI: 1487974077
Provider Name (Legal Business Name): DAWN MOELLER L.AC. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10211 SW BARBUR BLVD STE 205A
PORTLAND OR
97219-5935
US

IV. Provider business mailing address

3758 SE TWELVE OAKS ST
HILLSBORO OR
97123-9206
US

V. Phone/Fax

Practice location:
  • Phone: 503-688-0648
  • Fax:
Mailing address:
  • Phone: 503-688-0648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number152896
License Number StateOR

VIII. Authorized Official

Name: DAWN MOELLER
Title or Position: LICENSED ACUPUNCTURIST
Credential: L.AC.
Phone: 503-688-0648