Organization
SOURCE INTEGRATIVE MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARA CANTOR L.AC (OWNER)
(503) 928-6728
Entity
Organization
Contact information
Practice address
4424 NE GLISAN ST, PORTLAND, OR 97213-2331
(503) 928-6728
(503) 296-5917
Mailing address
4424 NE GLISAN ST, PORTLAND, OR 97213-2331
(503) 928-6728
(503) 296-5917
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC165411
OR
Other
Enumeration date
07/21/2015
Last updated
08/06/2015
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