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General NPI Number Information
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NPI Number | 1033582275
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Entity Type | Organization
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Legal Business Name | ROWAN EVERARD LLC
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Dates
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Enumeration Date | 11/10/2015
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Last Update Date | 11/10/2015
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Provider Practice Location Address
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Address Line | 5944 N KERBY AVE
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City | PORTLAND
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State | OR
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Zip | 97217-2008
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Country | US
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Telephone | 630-297-3705
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Fax |
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Provider Business Mailing Address
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Address Line | 5944 N KERBY AVE
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City | PORTLAND
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State | OR
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Zip | 97217-2008
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Country | US
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Telephone | 630-297-3705
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | ROWAN EVERARD
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Credential |
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Telephone | 630-297-3705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC174171
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License Number State | OR
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