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General NPI Number Information
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NPI Number | 1841464187
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Entity Type | Organization
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Legal Business Name | JOHN C. SLOSBERG L.A.C., PC
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 2143 NE BROADWAY
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City | PORTLAND
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State | OR
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Zip | 97232-1512
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Country | US
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Telephone | 503-320-1342
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Fax | 503-331-0164
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Provider Business Mailing Address
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Address Line | 3272 NE DAVIS ST
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City | PORTLAND
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State | OR
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Zip | 97232-3243
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Country | US
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Telephone | 503-731-8878
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Fax | 503-331-0164
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN CHARLES SLOSBERG
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Credential |
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Telephone | 503-731-8878
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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 | AC00358
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License Number State | OR
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