Individual
JUSTIN SOUVANLASY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
8136 SE FOSTER RD, PORTLAND, OR 97206-4288
(503) 374-9995
Mailing address
9841 SE HULT ST, PORTLAND, OR 97266-1341
(971) 240-8512
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
6169
OR
Other
Enumeration date
08/04/2022
Last updated
03/30/2023
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