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NPI Code Detail

MEDICARE: MR. ZACHARY ROBERT NELMS L.AC.

MEDICARE: MR. ZACHARY ROBERT NELMS L.AC.
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
1171100000XAcupuncturistAC01129OR

General Provider Information

NPI Number : 1518148949
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ZACHARY ROBERT NELMS L.AC.
Provider Business Mailing Address
First Line : 5935 WILLOW LN
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-5344
Country : US
Telephone Number : 503-655-0044
Fax Number : 503-515-8099
Provider Business Practice Location Address
First Line : 5935 WILLOW LN
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-5344
Country : US
Telephone Number : 503-655-0044
Fax Number : 503-515-8099
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2007
Last Update Date : 11/14/2007

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