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General NPI Number Information
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NPI Number | 1912171273
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Entity Type | Organization
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Legal Business Name | SAMANTHA L BRODY ND, LAC, 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 | 6610 SW CAPITOL HWY
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City | PORTLAND
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State | OR
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Zip | 97239-1944
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Country | US
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Telephone | 503-977-0500
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Fax | 503-246-1309
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Provider Business Mailing Address
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Address Line | 6610 SW CAPITOL HWY
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City | PORTLAND
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State | OR
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Zip | 97239-1944
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Country | US
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Telephone | 500-397-7050
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAMANTHA L BRODY
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Credential | N. D., L. AC.
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Telephone | 503-977-0500
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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 | AC00586
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 880
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License Number State | OR
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