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Individual

CONNIE JAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
L.AC

Contact information

Practice address
4531 SE BELMONT ST STE 203, PORTLAND, OR 97215-1675
(503) 236-9609
(503) 236-2906
Mailing address
4531 SE BELMONT ST STE 203, PORTLAND, OR 97215-1675
(503) 236-9609
(503) 236-2906

Taxonomy

Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC164280
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500689110
OR
Enumeration date
01/30/2014
Last updated
07/02/2022
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