Individual
KELLY COREY SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
6018 SE STARK ST, PORTLAND, OR 97215-1990
(503) 808-9145
(503) 808-8085
Mailing address
3280 SE MADISON ST, PORTLAND, OR 97214-4249
(541) 232-4016
(503) 473-8085
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC169285
OR
Other
Enumeration date
01/29/2015
Last updated
01/29/2015
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