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General NPI Number Information
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NPI Number | 1588919831
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Entity Type | Organization
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Legal Business Name | LISA A. L. KOUZES, DC
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 07/23/2012
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Provider Practice Location Address
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Address Line | 9115 SW OLESON RD STE 103
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City | PORTLAND
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State | OR
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Zip | 97223-6876
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Country | US
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Telephone | 503-972-5601
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Fax | 503-972-5603
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Provider Business Mailing Address
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Address Line | 9115 SW OLESON RD STE 103
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City | PORTLAND
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State | OR
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Zip | 97223-6876
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Country | US
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Telephone | 503-972-5601
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Fax | 503-972-5603
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Authorized Official
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Title or Position | OWNER
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Name | DR. LISA A. L. KOUZES I
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Credential | DC
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Telephone | 503-972-5601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3727
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License Number State | OR
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