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NPI Code Detail

MEDICARE: JOSHUA MATTHEW LACROUTE LAC

MEDICARE: JOSHUA MATTHEW LACROUTE 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
1171100000XAcupuncturistAC150508OR

General Provider Information

NPI Number : 1922306034
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSHUA MATTHEW LACROUTE LAC
Provider Business Mailing Address
First Line : 505 NW 9TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97209-3578
Country : US
Telephone Number : 503-477-4399
Fax Number : 503-477-9197
Provider Business Practice Location Address
First Line : 505 NW 9TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97209-3578
Country : US
Telephone Number : 503-477-4399
Fax Number : 503-477-9197
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2011
Last Update Date : 03/14/2011

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Directions to “ JOSHUA MATTHEW LACROUTE LAC” Practice Location

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