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NPI Code Detail

MEDICARE: MARY JEAN BRINKMAN LAC

MEDICARE: MARY JEAN BRINKMAN LAC
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
1171100000XAcupuncturistAC153318OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356648349
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY JEAN BRINKMAN LAC
Provider Business Mailing Address
First Line : 5308 SE RHONE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97206-2962
Country : US
Telephone Number : 503-789-7661
Fax Number :
Provider Business Practice Location Address
First Line : 5308 SE RHONE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97206-2962
Country : US
Telephone Number : 503-789-7661
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2011
Last Update Date : 12/02/2024

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Directions to “ MARY JEAN BRINKMAN LAC” Practice Location

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