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General NPI Number Information
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NPI Number | 1346065075
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Entity Type | Organization
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Legal Business Name | TRACY ANDERSEN, DAOM, LAC
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 2301 NW THURMAN ST STE O
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City | PORTLAND
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State | OR
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Zip | 97210-2581
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Country | US
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Telephone | 503-250-3012
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Fax | 503-208-8028
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Provider Business Mailing Address
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Address Line | 2301 NW THURMAN ST STE O
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City | PORTLAND
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State | OR
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Zip | 97210-2581
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Country | US
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Telephone | 503-250-3012
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Fax | 503-208-8028
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Authorized Official
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Title or Position | DOCTOR
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Name | TRACY ANDERSEN
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Credential | DAOM, LAC
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Telephone | 503-250-3012
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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 |
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License Number State |
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