Individual
SHAWN P. KINSELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC, LMT
Contact information
Practice address
3605 SE 26TH AVE, PORTLAND, OR 97202-2953
(503) 234-0325
Mailing address
3743 SE CORA ST, PORTLAND, OR 97202-3237
(310) 488-0949
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC202894
OR
225700000X
Massage Therapist
17765
OR
Other
Enumeration date
02/08/2011
Last updated
07/16/2021
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