MEDICARE: MARJORIE BAILEY DAHM, 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
1	171100000X	Acupuncturist	AC221163	OR

General Provider Information

NPI Number	:	1982437463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARJORIE BAILEY DAHM, L.AC

Provider Business Mailing Address
First Line	:	4810 SE FRANKLIN ST UNIT B
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-3153
Country	:	US
Telephone Number	:	239-850-0355
Fax Number	:

Provider Business Practice Location Address
First Line	:	4810 SE FRANKLIN ST UNIT B
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-3153
Country	:	US
Telephone Number	:	239-850-0355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2024
Last Update Date	:	08/21/2024

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