Individual
VIDHRA MAUREEN JACKIW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
1623 SE 6TH AVE STE 200, PORTLAND, OR 97214-3502
(971) 350-8508
(971) 275-1552
Mailing address
1623 SE 6TH AVE STE 200, PORTLAND, OR 97214-3502
(971) 350-8508
(971) 275-1552
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC169857
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500773023
—
OR
Enumeration date
10/05/2014
Last updated
03/18/2024
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