Individual
AIDEN ELLIOT LAWRENCE KOPCHINSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
221 SE 11TH AVE STE 226, PORTLAND, OR 97214-1357
(503) 567-6864
Mailing address
9635 N VAN HOUTEN AVE, PORTLAND, OR 97203-1962
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18759
OR
Other
Enumeration date
07/26/2017
Last updated
07/26/2017
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