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Organization
ROOT & BRANCH
Active
Organization
ROOT & BRANCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRAVIS KERN LAC (OWNER)
(504) 451-1739
Entity
Organization
Contact information
Practice address
7642 SW CAPITOL HWY, PORTLAND, OR 97219-2437
(504) 451-1739
(503) 486-7068
Mailing address
6506 SE 89TH AVE, PORTLAND, OR 97266-5346
(504) 451-1739
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC186554
OR
Other
Enumeration date
02/27/2018
Last updated
02/27/2023
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