Individual
MR. PORTER MIKEL NILSSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSOM, L.AC.
Contact information
Practice address
3122 W CARY ST STE 220, RICHMOND, VA 23221-3500
(804) 938-6457
Mailing address
610 N NANSEMOND ST APT 4, RICHMOND, VA 23221-1540
(804) 938-6457
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
0121000440
VA
Other
Enumeration date
01/30/2009
Last updated
08/04/2020
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