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NPI Code Detail

MEDICARE: ALISSA LAMB LAC, MSAOM

MEDICARE: ALISSA LAMB LAC, MSAOM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171100000XAcupuncturist203207OR
2172M00000XMechanotherapist21493OR
3171100000XAcupuncturist61111651WA

General Provider Information

NPI Number : 1184085144
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALISSA LAMB LAC, MSAOM
Provider Business Mailing Address
First Line : 9514 N MOHAWK AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97203-1646
Country : US
Telephone Number : 415-646-5605
Fax Number :
Provider Business Practice Location Address
First Line : 2720 NE FLANDERS ST
Second Line :
City : PORTLAND
State : OR
Zip : 97232-3160
Country : US
Telephone Number : 971-302-7039
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2016
Last Update Date : 04/18/2024

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