Individual
MR. JUSTIN THOMAS JANICKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.AC, MACOM, DIPL.OM
Contact information
Practice address
5230 NE FREMONT ST, PORTLAND, OR 97213-1735
(716) 680-0636
Mailing address
5230 NE FREMONT ST, PORTLAND, OR 97213-1735
(716) 680-0636
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC01233
OR
Other
Enumeration date
12/05/2008
Last updated
12/05/2008
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